肝胆管结石病肝切除术后教科书式结局的影响因素分析

Influencing factors analysis of textbook outcome after hepatectomy for hepatolithiasis

  • 摘要: 目的 探讨肝胆管结石病肝切除术后实现教科书式结局(TO)的影响因素。方法 采用回顾性病例对照研究方法。收集2015年1月至2023年3月安徽医科大学第一附属医院收治的216例肝胆管结石病患者的临床病理资料;男 69例,女 147例;年龄为 61(22~85)岁。观察指标:(1)治疗情况。(2)肝切除术后TO情况。(3)肝切除术后实现TO的影响因素分析。正态分布的计量资料以x±s表示。偏态分布的计量资料以 M(范围)表示。计数资料以绝对数表示。单因素和多因素分析采用Logistic回归模型。结果 (1)治疗情况。216例患者均施行肝切除术,其中腹腔镜肝切除术45例,开腹肝切除术171例;解剖性肝切除术161例,非解剖性肝切除术55例。216例患者均行术中胆道镜探查、取石;其中170例Oddi括约肌功能正常,46例Oddi括约肌功能障碍。216例患者均行胆道引流,其中T管外引流198例,胆肠内引流18例。216例患者手术时间为(226±75)min,术中出血量为(106±82)mL。29例患者围手术期输血。14例患者发生术中严重不良事件。189例患者结石即时清除。183例患者术中留取胆汁进行细菌培养,其中76例细菌培养阳性。(2)肝切除术后TO情况。216例患者中,93例发生术后并发症,均经积极治疗后顺利出院。1例患者因肝衰竭术后90d内死亡,5例患者术后90d内再入院,18例患者术后结石残留。216例患者中,164例术后实现TO,52例术后未实现TO。(3)肝切除术后实现TO的影响因素分析。多因素分析结果显示:胆管炎、结石分布、手术入路、解剖性肝切除、结石即时清除和术后复查胆道镜是肝胆管结石病患者肝切除术后实现TO的独立影响因素(P<0.05)。结论 胆管炎、结石分布、手术入路、解剖性肝切除、结石即时清除和术后复查胆道镜是肝胆管结石病患者肝切除术后实现TO的独立影响因素。

     

    Abstract: Objective To investigate the influencing factors for textbook outcome (TO) after hepatectomy for hepatolithiasis. Methods Theretrospective case‐control study was conducted.The clinicopathological data of 216 patients with hepatolithiasis who were admitted to The First Affiliated Hospital of Anhui Medical University from January 2015 to March 2023 were collected. There were 69 males and 147 females, aged 61(range, 22?85)years. Observation indicators:(1) treatment situations; (2) TO after hepatectomy; (3) Influencing factors for TO after hepatectomy. Measurement data with normal distribution were represented as Mean±SD. Measurement data with skewed distribution were represented as M(range). Count data were expressed as absolute numbers. Logistic regression models were used for univariate and multifactorial analyses. Results (1) Treatment situations. All the 216 patients underwent hepatectomy, including 45 cases of laparoscopic hepatec‐tomies and 171 cases of open hepatectomies, 161 cases of anatomical hepatectomies and 55 cases of non‐anatomical hepatectomies. All the 216 patients underwent intraoperative choledochoscopy exploration and lithotripsy. There were 170 patients with normal Oddi sphincter function and 46 patients with Oddi sphincter dysfunction. All the 216 patients underwent biliary drainage, including 198 cases of external T‐tube drainage and 18 cases of internal bile‐intestinal drainage. The operation time was (226±75)minutes and volume of intraoperative blood loss was (106±82)mL. There were 29 patients with perioperative blood transfusion and 14 patients with intraoperative severe adverse events. There were 189 patients achieved immediate stone clearance. Of 183 patients with intraoperative bile cultures, 76 cases were positive for bacteria culture. (2) TO after hepatectomy. Of 216 patients, 93 cases had postoperative complications, all of which were successfully discharged after active treatment. One patient had surgery‐related death within 90 days after surgery, and the cause of death was liver failure. Five patients were readmitted within 90 days after surgery, and 18 patients had postoperative stone residual. Of 216 patients, 164 cases achieved TO postoperatively and 52 cases did not achieve TO postoperatively. (3) Influencing factors for TO after hepatectomy.Results of multivariate analysis showed that cholangitis, stone distribution, surgical approaches, ana‐tomical hepatectomy, immediate stone removal and postoperative review of choledochoscopy were independent influencing factors for TO after hepatectomy in patients with hepatolithiasis (P<0.05).Conclusion Cholangitis, stone distribution, surgical approaches, anatomical hepatectomy, immediate stone removal and postoperative review of choledochoscopy are independent influencing factors for TO after hepatectomy in patients with hepatolithiasis.

     

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