术前因素预测腹腔镜胆总管切开术后不良结局：多因素分析研究。
Preoperative factors predicting poor outcomes following laparoscopic choledochotomy: a multivariate analysis study.
机构信息
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yinzhou Second Hospital, Ningbo, China.
出版信息
Can J Surg. 2013 Aug;56(4):227-32. doi: 10.1503/cjs.003112.
BACKGROUND
Laparoscopic surgery for common bile duct stones varies procedurally from a transcystic approach to laparoscopic choledochotomy (LC) with or without biliary drainage. However, LC is a difficult procedure with higher documented morbidity than the transcystic approach. We retrospectively investigated risk factors for adverse outcomes of LC.
METHODS
We used logistic regression models to assess 4 categories of adverse outcomes: overall, complications, conversion to open operation and failed surgical clearance. We calculated the area under the receiver operating characteristic curve to evaluate diagnostic accuracy.
RESULTS
We included 201 patients who underwent LC in our analysis. Adverse outcomes occurred in 48 (23.9%) patients, complications occurred in 43 (21.4%), retained stones were observed in 8 (4%), and conversion to laparotomy occurred in 7 (3.5%). Multivariate analysis showed that total bilirubin (BIL) and the presence of medical risk factors (MRFs) were significant predictors of adverse outcomes and complications. We calculated the probability of adverse outcomes (p) using the following formula: logit(p) = 0.977 (MRFs) + 0.014 (BIL) - 2.919. p = EXP (logit(p)) ÷ [1+EXP (logit(p))]. According to their logit(p), all patients were divided into a low-risk group (logit(p) ≤ -1.32, n = 130) and a high-risk group (logit(p) > -1.32, n = 71). Patients in the low-risk group had about a 1 in 10 chance (12 of 130) of adverse outcomes developing. Of the 71 patients in the high-risk group, 36 (50.7%) experienced adverse outcomes.
CONCLUSION
High BIL and the presence of MRFs could predict adverse outcomes in patients undergoing LC.
背景
腹腔镜胆总管切开取石术（LC）的手术方式因经胆囊管途径或 LC 联合或不联合胆道引流而有所不同。然而，LC 是一种较为困难的手术，其并发症发生率高于经胆囊管途径。本研究回顾性分析了 LC 不良结局的危险因素。
方法
我们使用逻辑回归模型评估了 4 类不良结局：总体不良结局、并发症、中转开腹手术和手术未清除结石。我们计算了受试者工作特征曲线下面积以评估诊断准确性。
结果
我们纳入了 201 例行 LC 的患者。48 例（23.9%）患者出现不良结局，43 例（21.4%）患者发生并发症，8 例（4%）患者留有结石，7 例（3.5%）患者中转开腹手术。多变量分析显示，总胆红素（BIL）和存在医疗风险因素（MRFs）是不良结局和并发症的显著预测因素。我们使用以下公式计算不良结局的概率（p）：logit(p) = 0.977（MRFs）+ 0.014（BIL）-2.919。p = EXP（logit(p))÷[1+EXP（logit(p))]。根据其 logit(p)值，所有患者被分为低风险组（logit(p)≤-1.32，n = 130）和高风险组（logit(p)＞-1.32，n = 71）。低风险组患者发生不良结局的概率约为 1/10（130 例中有 12 例）。高风险组患者中，有 36 例（50.7%）发生不良结局。
结论
高 BIL 和存在 MRFs 可以预测 LC 患者的不良结局。
Zotero 插件