乙肝肝硬化合并胆囊结石患者腹腔镜胆囊切除术后并发症的影响因素分析
作者:
作者单位:

1.重庆市江津区中心医院,肝胆外科,重庆 400010;2.重庆市江津区中心医院,肾内科,重庆 402260,重庆 400010;3.重庆市江津区中心医院,重庆医科大学附属第二医院 肝胆外科,重庆 400010

作者简介:

冯华国,重庆市江津区中心医院副主任医师,主要从事肝胆胰脾疾病微创手术治疗及肝癌血管介入方面的研究。

通讯作者:

鲁灵, Email: fenghuaguo@126.com

中图分类号:

R657.4

基金项目:

重庆市自然科学基金资助项目(csct2019jcyj-msxmX0620);重庆市卫生局科学基金资助项目(2017ZBXM028)。


Analysis of influencing factors for postoperative complications in patients with hepatitis B virus-cirrhosis undergoing laparoscopic cholecystectomy
Author:
Affiliation:

1.Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010;2.Department of Nephrology, Chongqing Jiangjin District Central Hospital, Chongqing 402260, China, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010;3.Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010

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    摘要:

    背景与目的 术前充分评估乙肝肝硬化患者行腹腔镜胆囊切除术(LC)术后并发症的危险因素具有重要的临床价值。本研究探讨乙肝肝硬化合并胆囊结石患者行LC治疗的术后并发症危险因素。方法 选择2016年1月—2020年1月期间共计188例乙肝肝硬化合并胆囊结石行LC患者的临床资料进行回顾性分析,根据术后是否发生并发症分为并发症组和无并发症组。将两组患者的围手术期指标进行单因素与Logistic回归分析,以确定术后并发症的影响因素。结果 共36例患者出现术后并发症,总发生率为19.2%,其中Clavien-Dindo I、II和III(IIIa、IIIb)级并发症的发生率分别为9.6%(18/188)、5.3%(10/188)、4.3%(8/188),无Clavien-Dindo IV或V级并发症发生。分析结果显示,并发症组与无并发症组间在抗病毒治疗、腹水、门静脉高压、脾功能亢进、终末期肝病模型(MELD)评分、手术时间及术中出血量存在统计学差异(均P<0.05)。Logistic回归分析显示,MELD评分>10为独立危险因素(OR=2.775,P=0.032),而抗病毒治疗为保护因素(OR=0.527,P=0.027)。结论 乙肝肝硬化患者行LC是比较安全的,术前应鼓励该类患者抗病毒治疗,对于MELD评分>10的患者,术前积极行保肝治疗以改善肝功能,从而降低MELD评分。

    Abstract:

    Background and Aims A thorough preoperative assessment of risk factors for complications in patients with hepatitis B virus (HBV)-cirrhosis undergoing laparoscopic cholecystectomy (LC) is of great clinical significance. Therefore, this study was conducted to investigate the risk factors for complications in patients with HBV-cirrhosis after LC for concomitant gallbladder stones.Methods The clinical data of 188 patients with HBV-cirrhosis and gallbladder stones who underwent LC from January 2016 to January 2020 were collected for retrospective analysis. The patients were divided into complication group and non-complication group according to whether there were postoperative complications. Univariate analysis and multivariate Logistic regression analysis were performed on the perioperative variables of the two groups of patients to determine the influencing factors for postoperative complications.Results Of the patients, postoperative complications occurred in 36 cases, and the overall incidence rate was 19.2%, in which, the incidence rates for Clavien-Dindo I, II and III (IIIa、IIIb) complications were 9.6% (18/188), 5.3% (10/188) and 4.3% (8/188), respectively, and no Clavien-Dindo IV or V complications occurred. The results of statistical analysis showed that there were significant differences in antiviral therapy, the presence of ascites, portal hypertension or hypersplenism, model for end-stage liver disease (MELD) score, operative time and intraoperative blood loss between complication group and non-complication group (all P<0.05). Logistic regression analysis showed that MELD score greater than 10 was an independent risk factor (OR=2.775, P=0.032), while antiviral therapy was an independent protective factor (OR=0.527, P=0.027).Conclusion LC is relatively safe for patients with HBV-cirrhosis. For these patients, antiviral therapy should be recommended before operation, and liver protection treatment should be aggressively administered to reduce the MELD score before operation in those with MELD score greater than 10.

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冯华国,冯毅,龚建平,代国华,李斌,鲁灵.乙肝肝硬化合并胆囊结石患者腹腔镜胆囊切除术后并发症的影响因素分析[J].中国普通外科杂志,2021,30(8):902-908.

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  • 收稿日期:2020-12-27
  • 最后修改日期:2021-07-14
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  • 在线发布日期: 2021-09-02
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