Department of Surgery, Southmead Hospital, Bristol, BS10 5NB, UK.
Surg Endosc. 2011 Jan;25(1):130-9. doi: 10.1007/s00464-010-1146-3. Epub 2010 Jun 22.
The aim of this study was to identify preoperative factors associated with poor outcome following laparoscopic bile duct exploration.
Data regarding potential preoperative factors were collected prospectively and from a review of patient records of 436 patients who had undergone a laparoscopic bile duct exploration. A multivariate analysis was performed to identify significant predictors of five adverse outcomes: postoperative complication (stratified), conversion to open operation, prolonged hospital stay, bile leak following choledochotomy, and failure of surgical clearance of the duct.
The mean age was 57 years (range = 18-91) and 74% were female. No complications were experienced by 66.5% and 17% had a minor Clavien Grade I complication. There was one death. Clinically significant Clavien Grade II-V complications occurred more frequently in those of increasing age [OR = 1.03 (CI = 1.01-1.05), p = 0.02]. Increasing serum bilirubin [OR = 1.01 (CI = 1.00-1.01), p = 0.01] was associated with conversion to an open operation. Male sex [OR = 0.52 (CI = 0.27-0.99), p = 0.05], previous upper abdominal surgery [OR = 4.89 (CI = 1.10-21.74), p = 0.04], immunosuppressants [OR = 9.75 (CI = 1.06-89.93), p = 0.05], and a larger preoperative common bile duct diameter [OR = 1.16 (CI = 1.08-1.25), p < 0.001] were predictors of a prolonged hospital stay. No factors were identified as predictors of a controlled bile leak. Previous failed ERCP was not associated with adverse outcome.
Laparoscopic exploration of the bile duct is safe but age, comorbidity, and degree of jaundice increase the risk slightly.
本研究旨在确定与腹腔镜胆管探查术后不良结局相关的术前因素。
前瞻性收集和回顾性分析 436 例接受腹腔镜胆管探查术患者的潜在术前因素数据。采用多变量分析确定 5 种不良结局（术后并发症（分层）、转为开放手术、住院时间延长、胆总管切开术后胆漏和胆管清除失败）的显著预测因子。
平均年龄为 57 岁（范围 18-91 岁），74%为女性。66.5%无并发症，17%有轻微的 Clavien I 级并发症。有 1 例死亡。临床意义上的 Clavien II-V 级并发症在年龄较大的患者中更为常见[OR = 1.03（CI = 1.01-1.05），p = 0.02]。血清胆红素升高[OR = 1.01（CI = 1.00-1.01），p = 0.01]与转为开放手术相关。男性[OR = 0.52（CI = 0.27-0.99），p = 0.05]、既往上腹部手术[OR = 4.89（CI = 1.10-21.74），p = 0.04]、免疫抑制剂[OR = 9.75（CI = 1.06-89.93），p = 0.05]和术前胆总管直径较大[OR = 1.16（CI = 1.08-1.25），p <0.001]是住院时间延长的预测因子。没有发现预测胆汁控制良好泄漏的因素。既往失败的 ERCP 与不良结局无关。
腹腔镜胆管探查术是安全的，但年龄、合并症和黄疸程度略有增加风险。
