腹腔镜胆总管探查一期缝合术后胆囊结石合并胆总管结石患者胆道并发症的发生情况与预防策略

Research on the incidence, and prevention strategies of biliary complications in patients with cholecystolithiasis and calculus of common bile duct after laparoscopic common bile duct exploration with one-stage suture

摘要:

目的 分析腹腔镜胆总管探查术（LCBDE）一期缝合术后，胆囊结石合并胆总管结石患者胆道并发症的发生情况，并探索其发生的高危因素，进而提出针对性的预防策略。方法 回顾性分析2020年1月－2024年4月该院收治的201例LCBDE一期缝合术后胆囊结石合并胆总管结石患者的临床资料。术后随访3个月，观察术后胆道并发症发生情况，分析胆道并发症组和非胆道并发症组患者的临床资料，将差异有统计学意义的因素纳入多因素Logistic回归模型，分析影响胆囊结石合并胆总管结石患者LCBDE一期缝合术后发生胆道并发症的独立危险因素。结果 201例患者中，发生胆道感染12例，胆总管狭窄5例，胆漏13例，胆道并发症总发生率为14.93%（30/201）。多因素Logistic回归分析结果显示：糖尿病（OR＾ = 1.092，95%CI：1.040～1.147）、胆总管直径 < 1 cm（OR＾ = 1.097，95%CI：1.053～1.144）、胆总管下段结石嵌顿（OR＾ = 1.120，95%CI：1.062～1.180）、胆囊三角粘连（OR＾ = 1.099，95%CI：1.042～1.158）、胆汁浑浊（OR＾ = 1.082，95%CI：1.043～1.123）和手术时间 ≥ 2 h（OR＾ = 1.090，95%CI：1.044～1.138）是影响胆囊结石合并胆总管结石患者LCBDE一期缝合术后发生胆道并发症的独立危险因素（P < 0.05）。结论 胆囊结石合并胆总管结石患者LCBDE一期缝合术后胆道并发症发生风险较高，并发症的发生与糖尿病、胆总管直径 < 1 cm、胆总管下段结石嵌顿、胆囊三角粘连、胆汁浑浊和手术时间≥2 h有关，临床可据此制定针对性的预防策略，以预防胆道并发症的发生。

Abstract:

Objective To analyze the incidence of biliary complications in patients with cholecystolithiasis and calculus of common bile duct after laparoscopic common bile duct exploration (LCBDE) with one-stage suture, and explore the high-risk factors of its occurrence, and then put forward targeted prevention strategies.Methods The clinical data of 201 patients with cholecystolithiasis and calculus of common bile duct after LCBDE with one-stage suture in our hospital from January 2020 to April 2024 were retrospectively analyzed. After 3 months of follow-up, the incidence of postoperative biliary complications was observed, and the clinical data of patients in the biliary complications group and the non-biliary complications group were analyzed. The factors with statistically significant differences were included in the multivariate Logistic regression model to analyze the independent risk factors affecting the occurrence of patients with cholecystolithiasis and calculus of common bile duct after LCBDE with one-stage suture.Results Among the 201 patients, 12 had biliary tract infection, 5 had common bile duct stenosis, and 13 had bile leakage. The total incidence of biliary complications was 14.93% (30/201). Multivariate Logistic regression analysis showed that diabetes mellitus (OR＾ = 1.092, 95%CI: 1.040 ~ 1.147), common bile duct diameter < 1 cm (OR＾ = 1.097, 95%CI: 1.053 ~ 1.144), stone incarceration at the lower end of common bile duct (OR＾ = 1.120, 95%CI: 1.062 ~ 1.180), Calot triangle adhesion (OR＾ = 1.099, 95%CI: 1.042 ~ 1.158), bile turbidity (OR＾ = 1.082, 95%CI: 1.043 ~ 1.123) and operation time ≥ 2 h (OR＾ = 1.090, 95%CI: 1.044 ~ 1.138) were independent risk factors for patients with cholecystolithiasis and calculus of common bile duct after LCBDE with one-stage suture (P < 0.05).Conclusion The risk of patients with cholecystolithiasis and calculus of common bile duct after LCBDE with one-stage suture is high. The occurrence of complications is related to diabetes mellitus, common bile duct diameter < 1 cm, stone incarceration at the lower end of the common bile duct, Calot triangle adhesion, bile turbidity and operation time ≥ 2 h. Targeted prevention strategies can be formulated clinically to prevent the occurrence of biliary complications.