胆总管囊肿切除术胆漏的危险因素分析：一项病例对照研究

Analysis of Risk Factors of Bile Leakage after Choledochal Cyst Resection: A Case-Control Study

摘要: 目的：本研究旨在回顾过去10年在我院行胆总管囊肿切除术的患儿的先天性胆道扩张的经验，总结胆总管囊肿术后胆漏的原因以及预防的措施，指导胆总管囊肿患者围手术期准备，减少术后胆漏发生率及改善患者预后。方法：研究选取了我院从2012年到2021年间，接受胆总管囊肿切除肝管空肠Roux-en-Y吻合术的1014名患者的临床资料，采用单因素和多因素分析确定术后胆漏的发生率的影响因素。结果：34名患者(3.4%)术后发生了胆漏，单因素分析提示年龄(月)、三大经典症状、术前谷丙、术前谷草、术前白蛋白、术前血色素、术前白细胞、术后白蛋白、手术时间、尿量、ASA、体重、术后排便时间、拔胃管、拔腹引管时间、ICU日数、术中是否输血存在显著性差异。多因素分析提示手术时间、术后排便时间、拔胃管时间、拔腹引管时间存在显著性差异。总结：本研究结果表明手术时间为胆总管囊肿切除术后胆漏的独立危险因素。手术时间较长的患儿术后胆漏的可能性增加，需要格外的监督来预防术后胆漏的发生。

Abstract: Objective: This study aims to review the experience of congenital biliary dilatation in children who underwent choledochal cyst resection in our hospital in the past 10 years, summarize the causes and preventive measures of postoperative bile leakage of choledochal cyst, guide the perioperative preparation of patients with choledochal cyst, reduce the incidence of postoperative bile leakage and improve the prognosis of patients. Methods: The clinical data of 1014 patients who underwent choledochal cyst resection and Roux-en-Y hepaticojejunostomy in our hospital from 2012 to 2021 were selected. Univariate and multivariate analysis were used to determine the influencing factors of the incidence of postoperative bile leakage. Results: 34 patients (3.4%) had bile leakage after operation. Univariate analysis showed that there were significant differences in age (month), three classic symptoms, preoperative glutamic acid, preoperative cereal grass, preoperative albumin, preoperative hemoglobin, preoperative WBC, postoperative albumin, operation time, urine output, ASA, body weight, postoperative defecation time, gastric tube pulling, abdominal tube pulling time, ICU days and intraoperative blood transfusion and non intraoperative blood transfusion. Multivariate analysis showed that there were significant differences in operation time, postoperative defecation time, gastric tube pulling time and abdominal tube pulling time. Conclusion: The results of this study show that the operation time is an independent risk factor for bile leakage after choledochal cyst resection. Children with longer operation time are more likely to have postoperative bile leakage, and extra supervision is needed to prevent the occurrence of postoperative bile leakage.