腹腔镜下胆总管探查术一期缝合后胆漏的危险因素分析

Analysis of risk factors for bile leakage after laparoscopic common bile duct exploration with primary closure

目的探讨腹腔镜下胆总管探查术(LCBDE)一期缝合后胆漏发生的危险因素。方法回顾性分析2021年9月至2023年9月因胆总管结石于天津市中西医结合医院行LCBDE一期缝合的560例患者的临床资料,根据术后是否发生胆漏将患者分为胆漏组和未胆漏组。多因素分析影响术后胆漏发生的危险因素。结果共64例(11.4%)患者发生了不同程度的胆漏,其中A级胆漏55例,B级7例,C级2例。胆总管直径较小(OR=0.07,P<0.001)、高血压史(OR=4.56,P<0.001)及BMI较高(OR=1.17,P=0.002)是胆总管结石患者术后胆漏发生的危险因素。结论胆总管直径较小、合并高血压和肥胖的患者术后更易发生胆漏,对于存在上述危险因素的胆总管结石患者,应谨慎选择LCBDE一期缝合。

Objective To explore the risk factors for bile leakage after laparoscopic common bile duct exploration(LCBDE)with primary closure.Methods The clinical data of 560 patients with choledocholithiasis who underwent LCBDE with primary closure in Tianjin Hospital of Integrated Traditional Chinese and Western Medicine from September 2021 to September 2023 were retrospectively analyzed,and the patients were divided into the bile leak group and the non-bile leak group according to the occurrence of postoperative bile leakage.The risk factors affecting the occurrence of postoperative bile leakage were analyzed by multivariate analysis.Results A total of 64 cases(11.4%)experienced varying degrees of bile leakage,including 55 cases of grade A bile leakage,7 cases of grade B,and 2 cases of grade C.The thin common bile duct(OR=0.07,P<0.001),history of hypertension(OR=4.56,P<0.001),and high BMI(OR=1.17,P=0.002)were the risk factors for postoperative bile leakage in patients with choledocholithiasis.Conclusion Patients with thin common bile duct,hypertension and obesity are more likely to occur postoperative bile leakage.Patients with choledocholithiasis who have the above high-risk factors should be cautious in choosing LCBDE with primary closure.