腹腔镜胆囊切除术胆管损伤的临床分析研究

发布时间：2018-11-21 20:26

【摘要】：目的：通过比较腹腔镜胆囊切除术(Laparoscopic Cholecystectomy,LC)患者的一般情况,分析腹腔镜胆囊切除术所致胆管损伤(Bile Duct Injury,BDI)的相关危险因素,探讨胆管损伤的防治措施,从而减少胆管损伤的发生率,改善患者愈后。方法：回顾性分析2006年1月至2015年12月昆明医科大学第一附属医院肝胆外科收治的8610例行LC的患者中出现胆管损伤患者的临床病历资料(其中急性胆囊炎合并胆囊结石16例,慢性胆囊炎合并胆囊结石21例,胆囊息肉4例,Mirizzi综合征1例),通过卡方检验(当T1时采用四格表资料的Fisher确切概率法)和Logistic回归分析,从性别、年龄、胆囊壁厚度、胆囊炎症程度、胆囊三角解剖变异、手术操作因素、医师经验等方面探讨42例胆管损伤患者的相关危险因素及独立危险因素,同时比较胆管损伤能否于术中及时发现并处理(42例胆管损伤患者中,34例于术中发现并及时处理,8例于术后发现并择期相应处理)。结果：单因素分析结果显示：患者性别与胆管损伤的发生无关,患者年龄、炎症分期、胆囊壁厚度、胆囊三角解剖、手术操作因素、手术经验与胆管损伤有关联(P0.05)。多因素非条件Logistic回归分析结果显示：胆囊三角解剖、胆囊壁厚度、手术经验是胆管损伤的独立危险因素(P0.05)。42例胆管损伤患者中,34例于术中发现并及时处理,8例于术后发现并择期相应处理,可见LC所致胆管损伤多于术中发现并及时处理(X2=3.462,P=0.021)。结论：患者年龄、炎症分期、胆囊壁厚度、胆囊三角解剖、手术操作因素、手术经验与胆管损伤密切相关。胆囊三角解剖、胆囊壁厚度、手术经验是胆管损伤的独立危险因素。胆管损伤一般能在术中及时发现并处理。
[Abstract]:Objective: to compare the general situation of patients with laparoscopic cholecystectomy (Laparoscopic Cholecystectomy,LC), analyze the risk factors of bile duct injury caused by laparoscopic cholecystectomy (Bile Duct Injury,BDI), and explore the preventive and therapeutic measures of bile duct injury. In order to reduce the incidence of bile duct injury, improve the patient after recovery. Methods: the clinical records of 8610 patients with LC in hepatobiliary surgery, first affiliated Hospital of Kunming Medical University, from January 2006 to December 2015, were retrospectively analyzed. Among them, 16 cases were acute cholecystitis complicated with gallstone. 21 cases of chronic cholecystitis complicated with gallstone, 4 cases of gallbladder polyp and 1 case of Mirizzi syndrome were analyzed by chi-square test (Fisher exact probability method) and Logistic regression analysis according to sex, age and thickness of gallbladder wall. The degree of cholecystitis, anatomical variation of gallbladder triangle, operative factors and physician's experience were studied in 42 patients with bile duct injury. At the same time, we compared whether bile duct injury could be detected and dealt with in time during operation (34 cases were found and dealt with in operation in 34 cases, 8 cases were found in postoperative period and treated in a selective period) in 42 cases of bile duct injury. Results: the results of univariate analysis showed that the gender of the patients was not related to the occurrence of bile duct injury, the age of the patients, the inflammatory stage, the thickness of the gallbladder wall, the anatomy of the gallbladder triangle, the operative factors and the surgical experience were related to the bile duct injury (P0.05). Multivariate conditional Logistic regression analysis showed that cholecystic triangle anatomy, gallbladder wall thickness and surgical experience were independent risk factors for bile duct injury (P0.05). Among 42 cases of bile duct injury, 34 cases were found during operation and treated in time. The bile duct injury caused by LC was found more frequently in 8 cases after operation and was treated in time (X2P 3.462P0. 021). Conclusion: age, inflammatory stage, thickness of gallbladder wall, anatomy of gallbladder triangle, operative factors and surgical experience are closely related to bile duct injury. Anatomy of gallbladder triangle, thickness of gallbladder wall and surgical experience are independent risk factors for bile duct injury. Bile duct injury can be found and treated in time during operation.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R657.4

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