腹腔镜胆囊切除术后腹泻发生的相关因素分析

发布时间：2018-05-18 18:39

  本文选题：胆囊切除术后 + 腹泻　； 参考：《大连医科大学》2017年硕士论文

【摘要】：目的:通过回顾性研究的调查方法,探讨腹腔镜胆囊切除术后患者第1、3、6、9个月腹泻发生的发病率,术后腹泻出现及消失的时间以及患者性别、年龄、体重身高指数、术前胆囊收缩功能情况、精神心理状况、饮食等因素与腹腔镜胆囊切除术后腹泻发生的相关性,以分析腹腔镜胆囊切除术后患者发生腹泻的相关因素,以期对术后腹泻的评估、预防以及对需行腹腔镜胆囊切除术患者的治疗提供临床指导。方法:通过检索2014年12月-2015年12月间于大连医科大学附属第一医院腹腔镜外科行腹腔镜胆囊切除术后患者的相关基本病例资料,并通过电话联系、微信或者电子邮件方式分别对患者术后1个月、3个月、6个月、9个月进行相关内容随访。随访过程中排除因术中误伤出现胆管损伤、胆瘘及肠瘘患者,随访期间患者术后继发胆总管结石而行手术治疗患者,因胃肠道疾病而行胃肠道手术者、行开腹手术治疗疾病患者以及随访期间发生感染性腹泻者或者术前患有引起腹泻相关疾病患者。目前尚没有明确诊断PCD的临床标准,其临床特征尚未有统一描述,通过复习八版《诊断学》腹泻诊断、罗马Ⅲ诊断标准以及查阅相关文献确定PCD基本临床特征:①有腹腔镜下胆囊切除病史、术前无腹泻症状。②术后排便规律改变、排便次数≥3次/天。③发生腹泻时存在紧迫感、无体温升高、恶心、呕吐,无腹痛及黏液脓血便。④排便性状为不成形便、水样便或可见脂滴。通过查阅患者入院时基本资料,设计相关表格记录患者性别、年龄并计算出患者体重身高指数;通过查阅患者术前胆囊功能彩色多普勒超声检查,记录患者术前胆囊收缩功能情况;患者精神心理状态评估采用焦虑自评量表进行综合评分。结果:检索2014年12月-2015年12月间行腹腔镜胆囊切除术患者病例资料,其中122例符合随访标准。术后1、3、6、9月腹泻发生率分别为54%、33%、28%、19%(χ2=36.80,P0.01),差异具有统计学意义。有54%的患者术后第1个月即出现腹泻,73%患者于术后第9个月随访中腹泻症状可完全消失,但仍有19%患者腹泻症状持续存。术后腹泻的发生与性别无明显统计学差异,性别与腹泻的发生无确切相关性(χ2=0.07,P=0.85)。随着患者年龄的增长,PCD发生率逐步下降,通过χ2检验(χ2=12.44,P=0.02),患者年龄与PCD的发生具有统计学意义。符合纳入标准患者按胆囊收缩功能分组PCD发病率为:胆囊收缩功能20%,PCD发病率为11%;20%≤胆囊收缩功能≤30 PCD发病率为22%;胆囊收缩功能30%,PCD发病率为36%,胆囊收缩功能与PCD发生呈正相关性,患者胆囊收缩功能与PCD的发生具有统计学意义(χ2=23.72,,P0.01)。符合纳入标准患者按体重身高指数分组,正常患者PCD发生率为13%;超重患者PCD发生率为30%;肥胖患者PCD发生率为26%,患者BMI与PCD的发生具有统计学意义(χ2=23.72,P0.01)。符合纳入标准患者分别按照精神焦虑程度分组,其中无精神焦虑组PCD发病率为15%;轻度焦虑患者PCD发病率24%;中度焦虑患者PCD发病率为25%;重度焦虑患者PCD发病率为6%,随着患者精神焦虑程度加重,PCD发生率逐步升高(χ2=13.58,P=0.01)。符合纳入标准患者分别按饮食情况分为正常饮食组,低脂饮食组,其中正常饮食组PCD发病率为48%,低脂饮食组PCD发病率为22%(χ2=13.51,P0.01),患者饮食情况与PCD的发生具有统计学意义。结论:腹腔镜胆囊切除术后患者腹泻的发病率随时间的推移逐步下降,部分患者腹泻症状可完全消失;腹腔镜胆囊切除术后腹泻的发生与性别差异无明确相关性;但与年龄、体重身高指数、术前胆囊功能情况、精神心理状况、饮食等因素密切相关。
[Abstract]:Objective: To investigate the incidence of diarrhea in 1,3,6,9 months after laparoscopic cholecystectomy, the occurrence and disappearance of postoperative diarrhea, the sex, age, weight and height index of the patients, the preoperative gallbladder contraction function, the psychosocial status, diet and other factors and laparoscopic cholecystectomy. The correlation of postdiarrhea occurred to analyze the related factors of diarrhea in patients after laparoscopic cholecystectomy, with a view to assessing postoperative diarrhea, preventing and providing clinical guidance for the treatment of patients requiring laparoscopic cholecystectomy. Methods: through the retrieval of the abdomen of the First Affiliated Hospital of Dalian Medical University, December 2014, in December -2015 years. The basic case data of the patients after laparoscopic cholecystectomy were followed up by telephone connection, WeChat or e-mail were followed up for 1 months, 3 months, 6 months, and 9 months respectively. During the follow-up, the bile duct injury, biliary fistula and intestinal fistula were excluded, and the patients were followed up during the follow-up period. Patients with secondary choledocholithiasis after operation were operated on, patients who underwent gastrointestinal surgery for gastrointestinal diseases, open surgery to treat patients with disease, patients with infectious diarrhea during follow-up or patients with diarrhea related diseases before operation. There is no definite clinical standard for diagnosing PCD and its clinical features have not yet been unified. Description, by reviewing the diagnosis of the eighth edition of the diagnosis, the diagnosis of diarrhea, the Rome III diagnostic standard and consulting the relevant literature to determine the basic clinical features of PCD: (1) there is a history of laparoscopic cholecystectomy, no symptoms of diarrhea before operation. (2) the change of bowel movement and the number of defecation more than 3 times / day. (3) there is a sense of urgency, no temperature rise, nausea, vomiting, when abdominal diarrhea occurs. There was no abdominal pain and mucous purulent stool. 4. Defecation characters were unformable stool, water urine or visible lipid droplets. By consulting the basic data of the patient's admission, related forms were designed to record the patient's sex, age, and the body weight and height index of the patient; the preoperative gallbladder contractions were recorded by examination of the preoperative gallbladder function color Doppler ultrasonography. The patient's mental state assessment was evaluated by the self rating anxiety scale. Results: the data of patients with laparoscopic cholecystectomy in December 2014 -2015 year and December were retrieved. 122 cases were consistent with follow up criteria. The incidence of diarrhea in 1,3,6,9 months after operation was 54%, 33%, 28%, 19% (x 2=36.80, P0.01), and the difference was statistically significant. 54% of the patients had diarrhoea at first months after operation, and 73% patients had complete disappearance of diarrhea in ninth months after the operation, but there were still 19% patients with persistent diarrhea. There was no statistically significant difference in the occurrence of diarrhoea after operation. There was no definite correlation between the sex and the occurrence of diarrhea (x 2=0.07, P=0.85). The incidence of PCD decreased gradually. The incidence of PCD was statistically significant by the x 2 test (x 2=12.44, P=0.02). The incidence of PCD in the group according to the standard of cholecystoconstriction was 20%, the incidence of PCD was 11%, and the incidence of cholecystokinin less than 30 PCD was 22%, and gallbladder contractile function 30%, PCD hair was found. The disease rate was 36%, the gallbladder contractile function was positively correlated with the occurrence of PCD. The gallbladder contractile function and the occurrence of PCD were statistically significant (x 2=23.72, P0.01). The patients were grouped according to the body weight and height index (P0.01). The incidence of PCD in normal patients was 13%, the incidence of PCD in overweight patients was 30%, the incidence of PCD in obese patients was 26%, BMI and PCD in patients were BMI and PCD. The incidence was statistically significant (x 2=23.72, P0.01). The patients in accordance with the inclusion criteria were grouped according to the mental anxiety level respectively, among them, the incidence of PCD in the non mental anxiety group was 15%, the incidence of PCD in mild anxiety patients was 24%, the incidence of PCD in moderate anxiety patients was 25%, the incidence of PCD in severe anxiety patients was 6%, and the degree of mental anxiety was aggravated, PCD The incidence was gradually increased (x 2=13.58, P=0.01). The patients were divided into normal diet group and low fat diet group according to the diet. The incidence of PCD in normal diet group was 48%, the incidence of PCD in low fat diet group was 22% (x 2=13.51, P0.01). The diet and PCD were statistically significant. Conclusion: laparoscopic cholecystectomy The incidence of diarrhoea in the patients gradually decreased with time, and the symptoms of diarrhea in some patients disappeared completely. The occurrence of diarrhea after laparoscopic cholecystectomy had no definite correlation with sex difference, but it was closely related to age, body weight and height index, preoperative gallbladder function, mental condition, diet and other factors.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.4
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本文编号：1906754