摘要
目的:基于倾向性评分匹配法探讨腹腔镜下胆囊切除术后并发胆漏的风险因素。方法:回顾性分析2017年2月至2023年6月在河南省第二人民医院行腹腔镜下胆囊切除术的1031例患者的临床资料,根据术后是否并发胆漏分为并发组(n=56)和未并发组(n=975)。采用倾向性评分匹配法,按照1∶1比例匹配并发组和未并发组年龄、性别、体质量指数(BMI)、吸烟史、饮酒史、高血压史、糖尿病史、Child-Pugh分级、美国麻醉医师协会(ASA)分级资料。匹配后,采用Logistic回归分析法分析腹腔镜下胆囊切除术后并发胆漏的风险因素。结果:并发组和未并发组通过1∶1倾向性评分匹配后,共成功匹配51对患者,两组年龄、性别、BMI、吸烟史、饮酒史、高血压史、糖尿病史、Child-Pugh分级、ASA分级均达到均衡(P>0.05);匹配后,两组手术时间、胆囊萎缩、胆囊炎症、胆囊颈部结石、胆囊结石数量比较差异均无统计学意义(P>0.05),并发组主刀医师临床经验<5年、局部解剖变异、Calot三角粘连、胆囊与周围脏器粘连及胆囊壁厚度≥5 mm占比均高于未并发组(P<0.05);Logistic回归分析显示,主刀医师临床经验<5年、局部解剖变异、Calot三角粘连、胆囊与周围脏器粘连、胆囊壁厚度≥5 mm是腹腔镜下胆囊切除术后并发胆漏的独立危险因素(P<0.05)。结论:经倾向性匹配年龄、性别、BMI、吸烟史、饮酒史、高血压史、糖尿病史、Child-Pugh分级、ASA分级资料后,主刀医师临床经验<5年、局部解剖变异、Calot三角粘连、胆囊与周围脏器粘连、胆囊壁厚度≥5 mm是腹腔镜下胆囊切除术后并发胆漏的风险因素。
Objective:To explore the risk factors of biliary leakage after laparoscopic cholecystectomy based on propensity score matching method.Methods:The clinical data of 1031 patients who underwent laparoscopic cholecystectomy in our hospital from February 2017 to June 2023 were retrospectively analyzed,and they were divided into concurrent group(n=56)and non-concurrent group(n=975)based on whether postoperative biliary leakage.The data of age,gender,body mass index(BMI),smoking history,drinking history,hypertension history,diabetes history,Child-Pugh classification and American Society of Anesthesiology(ASA)classification of the concurrent group and the non-concurrent group were matched according to the 1∶1 ratio using propensity score matching method.After matching,the risk factors of biliary leakage after laparoscopic cholecystectomy were analyzed using Logistic regression analysis method.Results:After matching,51 pairs of patients were successfully matched between the concurrent group and non-concurrent group through the ratio of 1∶1,and the age,gender,BMI,smoking history,drinking history,hypertension history,diabetes history,Child-Pugh classification and ASA classification of the two groups were balanced(P>0.05).After matching,there was no statistically significant difference between the two groups in terms of surgical time,gallbladder atrophy,gallbladder inflammation,gallbladder neck stones and the number of gallbladder stones(P>0.05),and the proportion of the chief surgeon's clinical experience<5 years,local anatomical variation,Calot triangle adhesion,adhesion between gallbladder and surrounding organs and gallbladder wall thickness≥5 mm in the concurrent group were higher than those in the non-concurrent group(P<0.05).Logistic regression analysis showed that chief surgeon's clinical experience<5 years,local anatomical variation,Calot triangle adhesion,adhesion between gallbladder and surrounding organs and gallbladder wall thickness≥5 mm were independent risk factors for biliary leakage after laparoscopic cholecystectomy(P<0.05).Conclusion:After propensity matching the data of age,gender,BMI,smoking history,drinking history,hypertension history,diabetes history,Child-Pugh classification and ASA classification,chief surgeon's clinical experience<5 years,local anatomical variation,Calot triangle adhesion,adhesion between gallbladder and surrounding organs and gallbladder wall thickness≥5 mm are risk factors for biliary leakage after laparoscopic cholecystectomy.
作者
张萍
王莹
何智丽
ZHANG Ping;WANG Ying;HE Zhili(Department of General Surgery,the Second People's Hospital of Henan Province,Zhengzhou 451191,China;Surgery Teaching and Research Section,Henan Medical College,Zhengzhou 451191,China)
出处
《东南大学学报（医学版）》
CAS
2024年第4期593-599,共7页
Journal of Southeast University(Medical Science Edition)
关键词
腹腔镜
胆囊切除术
胆漏
风险因素
倾向性评分匹配法
laparoscope
cholecystectomy
biliary leakage
risk factor
propensity score matching method
