腹腔镜下胆囊切除术致胆道损伤的临床分析(1)
【摘要】 目的：探讨腹腔镜下胆囊切除术致胆道损伤的临床情况。方法：选取本院2010年2月-2013年6月普外科收治的腹腔镜下胆囊切除术致胆道损伤患者30例作为胆道损伤组，同时选取同期腹腔镜下胆囊切除术无胆道损伤患者200例作为对照组。采用单因素分析和多因素回归分析，总结胆道损伤的原因。结果：结果表明，两组患者术者、胆道异常结构、胆囊壁厚度、胆囊管长度、术中粘连、术中出血、胆囊管切断顺序比较差异均有统计学意义(P<0.05)，多因素回归分析可知，术者、胆道异常结构、胆囊管长度、术中粘连、术中出血、胆囊管切断顺序均是胆道损伤的危险因素(P<0.05)。结论：术者熟练操作，掌握胆道异常结构、胆囊管长度、术中粘连、术中出血、胆囊管切断顺序等情况，可以降低胆道损伤的风险性。
【关键词】 腹腔镜下胆囊切除术； 胆道损伤； 多因素回归分析
Clinical Analysis of Biliary Injury Caused by Laparoscopic Cholecystectomy/HU Li-chun，ZHAO Hai-sheng，ZHANG Ming-yi.//Medical Innovation of China，2015，12(20)：147-149
, 百拇医药
【Abstract】 Objective：To investigate the clinical setting of biliary injury caused by laparoscopic cholecystectomy.Method：30 patients with biliary injury caused by laparoscopic cholecystectomy in general surgery department of our hospital from February 2010 to June 2013 were selected as the biliary injury group，then 200 patients laparoscopic cholecystectomy without biliary injury were selected as the control group.The causes of biliary injury were summarized using single factor analysis and multifactor regression analysis.Result：The results suggested that there were statistically significant differences in the performer，biliary abnormal structure，gallbladder wall thickness，cystic duct length，intraoperative adhesion，hemorrhage during operation，the order of cystic duct to cut off between the two groups(P<0.05)，multifactor regression analysis showed that，the performer，biliary abnormal structure，cystic duct length，intraoperative adhesion，hemorrhage during operation，the order of cystic duct to cut off were risk factors for biliary injury(P<0.05).Conclusion：The performer for skilled operation，master the biliary abnormal structure，cystic duct length，intraoperative adhesion，hemorrhage during operation，the order of cystic duct to cut off，which can reduce the risk of biliary injury.
, 百拇医药
【Key words】 Laparoscopic cholecystectomy； Biliary injury； Multifactor regression analysis
First-author’s address：The Third People’s Hospital of Nanhai District in Foshan City，Foshan 528244，China
doi：10.3969/j.issn.1674-4985.2015.20.050
近年来随着人们饮食结构的变化，胆囊结石、胆囊炎的发生率呈现明显的上升趋势，手术治疗是临床常用的治疗方法，腹腔镜下胆囊切除术作为普外科的微创手术方式，逐渐得到了广泛的应用[1-2]。但是随之而来的腹腔镜下胆囊切除术引起的胆道损伤也引起了临床的广泛关注，其在临床的发生率为0.32%左右[3-4]。本研究通过对本院腹腔镜下胆囊切除术致胆道损伤患者临床资料进行分析，拟分析胆道损伤原因，以期为临床预防和治疗提供可靠的理论依据，现将结果报告如下。
1 资料与方法
1.1 一般资料 选取本院2010年2月-2013年6月普外科收治的腹腔镜下胆囊切除术致胆道损伤患者30例作为胆道损伤组，其中男18例，女12例，年龄23～75岁，平均(55.0±11.4)岁。腹腔镜下胆囊切除术致胆道损伤患者均有不同程度的右上腹部疼痛、发热、恶心，疼痛有向肩胛骨放射性扩散趋势，通过B超结合临床症状进行确诊：胆囊炎者14例，胆囊息肉者6例，胆囊结石者10例，均通过腹腔镜胆囊切除术进行治疗。同时选取同期腹腔镜下胆囊切除术无胆道损伤患者200例作为对照组，其中男125例，女75例，年龄25～76岁，平均(54.1±10.7)岁。两组患者的年龄、性别等一般资料比较差异均无统计学意义(P>0.05)，具有可比性。, 百拇医药(胡立春 赵海生 张明仪)
【关键词】 腹腔镜下胆囊切除术； 胆道损伤； 多因素回归分析
Clinical Analysis of Biliary Injury Caused by Laparoscopic Cholecystectomy/HU Li-chun，ZHAO Hai-sheng，ZHANG Ming-yi.//Medical Innovation of China，2015，12(20)：147-149
, 百拇医药
【Abstract】 Objective：To investigate the clinical setting of biliary injury caused by laparoscopic cholecystectomy.Method：30 patients with biliary injury caused by laparoscopic cholecystectomy in general surgery department of our hospital from February 2010 to June 2013 were selected as the biliary injury group，then 200 patients laparoscopic cholecystectomy without biliary injury were selected as the control group.The causes of biliary injury were summarized using single factor analysis and multifactor regression analysis.Result：The results suggested that there were statistically significant differences in the performer，biliary abnormal structure，gallbladder wall thickness，cystic duct length，intraoperative adhesion，hemorrhage during operation，the order of cystic duct to cut off between the two groups(P<0.05)，multifactor regression analysis showed that，the performer，biliary abnormal structure，cystic duct length，intraoperative adhesion，hemorrhage during operation，the order of cystic duct to cut off were risk factors for biliary injury(P<0.05).Conclusion：The performer for skilled operation，master the biliary abnormal structure，cystic duct length，intraoperative adhesion，hemorrhage during operation，the order of cystic duct to cut off，which can reduce the risk of biliary injury.
, 百拇医药
【Key words】 Laparoscopic cholecystectomy； Biliary injury； Multifactor regression analysis
First-author’s address：The Third People’s Hospital of Nanhai District in Foshan City，Foshan 528244，China
doi：10.3969/j.issn.1674-4985.2015.20.050
近年来随着人们饮食结构的变化，胆囊结石、胆囊炎的发生率呈现明显的上升趋势，手术治疗是临床常用的治疗方法，腹腔镜下胆囊切除术作为普外科的微创手术方式，逐渐得到了广泛的应用[1-2]。但是随之而来的腹腔镜下胆囊切除术引起的胆道损伤也引起了临床的广泛关注，其在临床的发生率为0.32%左右[3-4]。本研究通过对本院腹腔镜下胆囊切除术致胆道损伤患者临床资料进行分析，拟分析胆道损伤原因，以期为临床预防和治疗提供可靠的理论依据，现将结果报告如下。
1 资料与方法
1.1 一般资料 选取本院2010年2月-2013年6月普外科收治的腹腔镜下胆囊切除术致胆道损伤患者30例作为胆道损伤组，其中男18例，女12例，年龄23～75岁，平均(55.0±11.4)岁。腹腔镜下胆囊切除术致胆道损伤患者均有不同程度的右上腹部疼痛、发热、恶心，疼痛有向肩胛骨放射性扩散趋势，通过B超结合临床症状进行确诊：胆囊炎者14例，胆囊息肉者6例，胆囊结石者10例，均通过腹腔镜胆囊切除术进行治疗。同时选取同期腹腔镜下胆囊切除术无胆道损伤患者200例作为对照组，其中男125例，女75例，年龄25～76岁，平均(54.1±10.7)岁。两组患者的年龄、性别等一般资料比较差异均无统计学意义(P>0.05)，具有可比性。, 百拇医药(胡立春 赵海生 张明仪)