摘要
目的探讨自体带血管蒂胃瓣组织治疗良性胆管狭窄的安全性及并发症发生的相关危险因素。方法回顾性分析2006年1月至2022年5月解放军总医院92例应用自体带血管蒂的胃瓣组织修复良性胆管狭窄患者的临床病例资料,其中男40例,女52例,年龄25~79(50.5±12.9)岁。记录患者围手术期的体质指数(BMI)、住院天数、血红蛋白、血小板计数、术中胆汁细菌培养阳性数等临床资料,采用多因素logistic回归模型分析术后并发症的相关影响因素。患者出院后进行长期随访,评价自体带血管蒂胃瓣组织治疗良性胆管狭窄手术的远期疗效。结果患者术后近期并发症发生率为26.1%(24/92)。单因素分析显示术前行胆肠吻合术、术中胆汁细菌培养阳性、术前低血红蛋白、术前低血小板计数与带血管蒂胃瓣修复胆管狭窄术后并发症发生具有相关性(均P<0.05)。多因素分析显示,术前低血小板(OR=0.990,95%CI:0.982~0.998,P=0.015)、术前低血红蛋白(OR=4.953,95%CI:1.405~15.010,P=0.012)和术中胆汁细菌培养阳性(OR=19.338,95%CI:3.618~103.360,P<0.001)是术后并发症发生的危险因素。患者远期随访优良率为92.0%。结论带血管蒂胃瓣修复良性胆管狭窄手术安全可行,并发症发生相对较低,为胆管损伤和胆管狭窄的外科治疗提供了一个可靠的选择。
Objective To investigate the complication rate and risk factors associated with using autologous gastric flap tissue with a vascular tip to treat benign biliary strictures.Methods A retrospective analysis was conducted on clinical data of 92 patients with benign biliary stenosis who applied autologous gastric flap tissue to repair the stenosis at the PLA General Hospital from January 2006 to May 2022.Among them,there were 40 males and 52 females,aged from 25 to 79(50.5±12.9)years.The perioperative clinical data of the patients were recorded(Body Mass Index、preoperative platelets et.),and a multivariate logistic regression model was used to analyze the factors influencing postoperative complications.Long-term follow-up was conducted to evaluate the long-term efficacy of autologous gastric flap tissue with vascular tissues for benign biliary stenosis surgery.Results The incidence of recent postoperative complications in patients was 26.1%,and univariate analysis showed that preoperative bile-intestinal anastomosis,positive intraoperative bile bacterial culture,low preoperative hemoglobin,and low preoperative platelet count were significantly associated with the occurrence of postoperative complications after biliary stenosis repair with a vascularized gastric flap(P<0.05).Multifactorial analysis showed that low preoperative platelets(OR=0.990,95%CI:0.982-0.998,P=0.015),low preoperative hemoglobin(OR=4.953,95%CI:1.405-15.010,P=0.012)and positive intraoperative bile bacterial culture(OR=19.338,95%CI:3.618-103.360,P<0.001)were independent risk factors for the development of postoperative complications.The excellent long-term follow-up rate of patients was 92.0%.Conclusions The procedure of repairing benign biliary stenosis with a vascularized gastric flap preserves the function of the sphincter of Oddi and reconstructs the normal physiological passage of the bile duct.This procedure is safe and feasible and provides a reliable option for the surgical treatment of bile duct injury and bile duct stenosis.
作者
郝嘉宁
孔哲
刘哲
王宇宏
潘孜博
王敬
Hao Jianing;Kong Zhe;Liu Zhe;Wang Yuhong;Pan Zibo;Wang Jing(Medical School of Chinese PLA,Beijing 100853,China;Faculty of Hepato-Pancreato-Biliary Surgery,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;The fourth center of the PLA General Hospital,Beijing 100037,China;468207 Unit PLA,Jiayuguan 735100,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2023年第22期1707-1713,共7页
National Medical Journal of China
关键词
胆管疾病
胆管狭窄
自体带血管蒂胃瓣
手术并发症
预后
Bile duct diseases
Biliary stricture
Autologous gastric flap with vascular tip
Complication
Prognosis
作者简介
通信作者:王敬,Email:wangjing301.hn@163.com
