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经腹腔镜逆行胆囊切除术治疗复杂胆囊结石术后并发症的危险因素分析
詹先锋,邱钧,项本宏,方寅,李志贵
0
芜湖市第一人民医院 肝胆外科;芜湖市第一人民医院 胃肠外科;芜湖市第一人民医院 急诊外科安徽芜湖 241000
摘要:
目的:探究经腹腔镜逆行胆囊切除术( LRC)治疗复杂胆囊结石( CGS)术后并发症的危险因素。方法:选择 2019年 3月—2021年 3月我院收治的 237例行 LRC治疗的 CGS患者作为研究对象,根据术后并发症发生情况分为无并发症组( 220例)和并发症组( 17例)。比较两组患者的一般资料;采用单因素及多因素 Logisitic回归分析影响患者术后并发症发生的危险因素;构建风险评分模型,并评价其预测价值。结果:本研究中有 17例 CGS患者行 LRC治疗后出现并发症,发生率为 7.17%(17/237),包括胆管损伤 3例,胆囊管过长 3例,结石 4例,胆漏 7例;糖尿病、胆囊壁厚度> 5 mm、胆囊颈部结石、周围脏器粘连、 Calot三角粘连、急诊手术均是影响 CGS患者行 LRC后并发症发生的危险因素(P< 0.05);将上述危险因素纳入风险评分模型,分别赋予 19、35、42、31、38、27分的权重,将总分 ≤ 69分定义为中危组, 69~152分定义为高危组,> 152分定义为极高危组,模型预测的区分度和校准度较好。结论:分析影响 CGS患者 LRC后并发症发生的危险因素,有利于临床上早期识别高危人群,对降低患者术后并发症发生率、改善患者预后有重要意义。
关键词:  腹腔镜逆行胆囊切除术  复杂胆囊结石  术后并发症  危险因素  风险评分模型
DOI:10.3969/j.issn.1007-6948.2022.02.012
投稿时间:2021-06-25
基金项目:
Analysis of Risk Factors for Postoperative Complications of Laparoscopic Retrograde Cholecystectomy for Complex Gallbladder Stones
ZHAN Xian-feng,QIU Jun,XIANG Ben-hong
Abstract:
Objective To explore the risk factors of complications after laparoscopic retrograde cholecystectomy (LRC) for the treatment of complex gallbladder stones (CGS) and provide reference value for the identi.cation of clinical risk factors. Methods The 237 CGS patients treated with LRC who were admitted to our hospital from March 2019 to March 2021 were selected as the research objects. According to the occurrence of postoperative complications, the patients were divided into uncomplicated group (220 cases) and complication group (17 cases). The general data of the two groups of patients were compared. The single-factor and multi-factor Logisitic regression analyzed the factors affecting the occurrence of postoperative complications in patients. A risk scoring model was constructed and its predictive value was evaluated. Results Postoperative complications included 3 cases of bile duct injury, 3 cases of cystic duct excessive length, 4 cases of calculus and 7 cases of bile leakage. The complication rate was 7.17% (17/237). The diabetes, gallbladder wall thickness >5 mm, gallbladder neck stones, adhesions of surrounding organs, Calot triangle adhesions and emergency surgery are all risk factors that affect the occurrence of complications after LRC in CGS patients (P<0.05). The above risk factors were included in the risk score. The model assigns weights of 19, 35, 42, 31, 38 and 27 points respectively. The total scores ≤ 69 points are de.ned as the intermediate risk group, >69 points and ≤ 152 points are de.ned as the high-risk group, and >152 points are de.ned as the extremely high-risk group. The model predicts better discrimination and calibration. Conclusion Analyzing the risk factors of complications after LRC in CGS patients and constructing a risk scoring model are conducive to early clinical identification of high-risk groups, which is of great significance for reducing the incidence of postoperative complications and improving the prognosis of patients.
Key words:  Laparoscopic retrograde cholecystectomy  complicated gallbladder stones  postoperative complications  risk factors  risk scoring model

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