胆总管探查引流术后T管窦道形成的相关因素分析
Analysis of factors associated with Ttube sinus tract formation after common bile duct exploration and Ttube drainage
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摘要:
目的:通过螺旋CT检查胆总管探查引流术后T管窦道的形成，探讨影响窦道形成的相关因素。方法:回顾性分析2011年5月至2013年12月右江民族医学院附属医院收治的465例行胆总管探查引流术患者的临床资料，术后2周行T管造影检查，判断有无胆道残留结石及狭窄，行螺旋CT检查T管窦道是否形成。选择患者性别、年龄、Alb、C反应蛋白、ALT、TBil、Hb、手术方式、T管周围积液、再次手术、糖尿病11个可能会影响窦道形成的因素进行分析。单因素分析采用χ2检验，多因素分析采用Logistic回归。结果:465例患者T管造影均通畅，且无残留结石；CT检查发现397例患者术后2周形成完整窦道，即行T管拔除。对于窦道形成不完整或未形成的患者，术后4周复查CT判断窦道形成后拔除T管。所有患者均无胆汁漏发生，痊愈出院。单因素分析结果显示：Alb、手术方式、T管周围积液、糖尿病是影响T管窦道形成的因素(χ2=50.750，7.671，19.022，15.373，P<0.05)；多因素分析结果显示：Alb<30 g/L，腹腔镜手术、T管周围积液、糖尿病是影响T管窦道形成的独立危险因素(OR=1.135，0.493，0.262，0.363；95%CI：1.061～1.214，0.280～0.865，0.104～0.658，0.156～0.843，P<0.05)。结论:胆总管探查引流术后2周可通过CT检查判断T管窦道形成情况而决定是否拔除T管。Alb<30 g/L、腹腔镜手术、T管周围积液、糖尿病是影响T管窦道形成的独立危险因素。
Abstract:Objective:To explore the risk factors affecting Ttube sinus tract formation after common bile duct exploration and Ttube drainage by spiral computed tomography (SCT)examination.
Methods:The clinical data of 465 patients undergoing common bile duct exploration and Ttube drainage at the Affiliated Hospital of Youjiang Medical College for Nationalities from May 2011 to December 2013 were retrospectively analyzed. The residual stones and biliary stricture were detected by Ttube cholangiography, and the Ttube sinus tract formation in all the patients was detected by SCT examination at postoperative week 2. 〖JP3〗The factors affecting sinus tract formation were analyzed, including gender, age, albumin (Alb), Creactive protein, alanine transaminase (ALT), total bilirubin (TBil), hemoglobin (Hb), surgical method, effusion around T tube, reoperation, diabetes. Univariate analysis was done using the chisquare test. Multivariate analysis was done using the Logistic regression.
Results Ttubes of 465 patients were clear without residual stones. Ttube in the 397 patients was removed when the sinus tract formation was confirmed by CT examination at postoperative week 2. Ttubes in other patients were removed when the
sinus tract formation was detected by CT reexamination at postoperative week 4. In univariate analysis, Alb, surgery method, effusion around Ttube and diabetes were important factors affecting Ttube sinus tract formation (χ2=50.750, 7.671, 19.022, 15.373, P<0.05). Alb<30 g/L, laparoscopic surgery, effusion around Ttube and diabetes were independent risk factors affecting Ttube sinus tract formation in multivariate analysis ［Odds ratio=1.135, 0.493, 0.262, 0.363; 95% confidence interval: 1.061-1.214, 0.280-0.865, 0.104-0.658, 0.156-0.843, P<0.05］.
Conclusions:The Ttube removal is determined according to the sinus tract formation by CT examination at week 2 after common bile duct exploration and Ttube drainage. Alb<30 g/L, laparoscopic surgery, effusion around Ttube and diabetes are independent risk factors affecting Ttube sinus tract formation. -
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