肝门部胆管癌患者手术相关并发症发生情况及其危险因素分析

Occurrence and risk factors of operation-related complications in patients with perihilar cholangiocarcinoma

目的了解肝门部胆管癌(perihilar cholangiocarcinoma,PHCC)患者手术相关并发症的发生状况,分析影响PHCC术后并发症发生的危险因素。方法回顾116例接受手术治疗的PHCC患者病历资料,统计患者术后并发症发生情况;采用单因素分析与多因素分析,探究影响PHCC患者术后发生并发症的危险因素。结果116例患者经手术治疗后并发胆管炎11例、胆瘘9例、腹腔感染5例、腹腔出血6例、肝功能衰竭10例,并发症发生率为35.34%。单因素及多因素分析显示,手术时间≥6 h、术前总胆红素水平≥171μmol/L、术前白蛋白水平<34 g/L、术前Bismuth分型为IV型、肿瘤大小≥3 cm、术后残余肝断面胆管开口数≥3个、术中出血量≥1000 mL是PHCC患者发生术后并发症的独立危险因素。结论PHCC患者手术后并发症发生率较高,临床应关注患者术前总胆红素、白蛋白水平和Bismuth分型、肿瘤大小,以及术中出血量、手术时间等,预防并发症的发生。

Objective To understand the incidence of operation-related complications in patients with perihilar cholangiocarcinoma(PHCC),and analyze the risk factors influencing the occurrence of postoperative complications in PHCC.Methods A retrospective review of medical records of 116 patients with perihilar cholangiocarcinoma(PHCC)who underwent surgical treatment was conducted to collect data on postoperative complications.Univariate and multivariate analyses were employed to explore the risk factors influencing the occurrence of postoperative complications in PHCC patients.Results Among the 116 patients who underwent surgical treatment,11 cases developed postoperative cholangitis,9 cases had bile leakage,5 cases experienced intra-abdominal infection,6 cases had intra-abdominal bleeding,and 10 cases suffered from liver function failure,resulting in a postoperative complication rate of 35.34%.Univariate analysis and multivariate analyses revealed that prolonged surgical duration(≥6 hours),preoperative total bilirubin levels(≥171μmol/L),preoperative albumin levels(<34 g/L),preoperative Bismuth type IV classification,tumor size(≥3 cm),postoperative residual hepatic bile duct openings(≥3),and intraoperative blood loss(≥1000 mL)were independent risk factors for the development of postoperative complications in PHCC patients.Conclusions The incidence of postoperative complications in patients with PHCC is relatively high.Clinical attention should be paid to patients'preoperative total bilirubin level,albumin level,Bismuth classification,tumor size,as well as intraoperative blood loss and surgical duration to prevent the occurrence of complications.