CAJ | 학술논문

目的评价腹腔镜脾切除术治疗门静脉高压症术后并发症的发生情况,并分析影响术后并发症发生的危险因素.方法回顾性分析2003年9月至2012年9月四川大学华西医院收治的65例行腹腔镜脾切除术的肝硬化门静脉高压症患者的临床资料.采用改良的Clavien分级系统分析术后并发症,并分析影响患者术后并发症发生的危险因素.计量资料采用t检验,计数资料采用x2检验和Fisher确切概率法,单因素及多因素分析采用Logistic回归模型分析.结果本组患者中,36例行全腹腔镜脾切除术(2例因术中出血中转开腹手术),29例行手助式腹腔镜脾切除术.术后16例患者发生20例次并发症,行全腹腔镜脾切除术患者术后并发症发生率为38.2％ (13/34),高于行手助式腹腔镜脾切除术患者的10.3％(3/29),两者比较,差异有统计学意义(x2=3.90,P＜0.05).按照改良Clavien分级系统,本组患者Ⅰ、Ⅱ、Ⅲa、Ⅲb、Ⅳa、Ⅳb、V级并发症分别为4、2、8、1、1、0、0例.全组患者术后住院时间为(8.4±2.9)d,发生Ⅱ、Ⅲ、Ⅳ级并发症的患者术后住院时间为(10.1±3.3)d,长于Ⅰ级和无并发症患者的(7.7±2.5)d,两者比较,差异有统计学意义(t=4.30,P ＜0.05).单因素分析结果显示:美国麻醉医师协会(ASA)分级和是否使用手助器与术后并发症的发生有关(x2=21.60,5.10,P＜0.05).多因素分析结果显示:ASA Ⅲ级和未使用手助器是术后并发症发生的独立危险因素(OR=23.60,4.60,P＜0.05).ASAⅢ级患者术后并发症发生率是Ⅱ级患者的17.00倍,未使用手助器患者术后并发症发生率是使用手助器患者的5.00倍.结论腹腔镜脾切除术治疗肝硬化门静脉高压症术后并发症的发生率高,但主要集中在ASAⅢ级以下患者,ASA分级和手助器的使用与术后并发症的发生有关.
목적 평개복강경비절제술치료문정맥고압증술후병발증적발생정황,병분석영향술후병발증발생적위험인소.방법 회고성분석2003년9월지2012년9월사천대학화서의원수치적65례행복강경비절제술적간경화문정맥고압증환자적림상자료.채용개량적Clavien분급계통분석술후병발증,병분석영향환자술후병발증발생적위험인소.계량자료채용t검험,계수자료채용x2검험화Fisher학절개솔법,단인소급다인소분석채용Logistic회귀모형분석.결과 본조환자중,36례행전복강경비절제술(2례인술중출혈중전개복수술),29례행수조식복강경비절제술.술후16례환자발생20례차병발증,행전복강경비절제술환자술후병발증발생솔위38.2％ (13/34),고우행수조식복강경비절제술환자적10.3％(3/29),량자비교,차이유통계학의의(x2=3.90,P＜0.05).안조개량Clavien분급계통,본조환자Ⅰ、Ⅱ、Ⅲa、Ⅲb、Ⅳa、Ⅳb、V급병발증분별위4、2、8、1、1、0、0례.전조환자술후주원시간위(8.4±2.9)d,발생Ⅱ、Ⅲ、Ⅳ급병발증적환자술후주원시간위(10.1±3.3)d,장우Ⅰ급화무병발증환자적(7.7±2.5)d,량자비교,차이유통계학의의(t=4.30,P ＜0.05).단인소분석결과현시:미국마취의사협회(ASA)분급화시부사용수조기여술후병발증적발생유관(x2=21.60,5.10,P＜0.05).다인소분석결과현시:ASA Ⅲ급화미사용수조기시술후병발증발생적독립위험인소(OR=23.60,4.60,P＜0.05).ASAⅢ급환자술후병발증발생솔시Ⅱ급환자적17.00배,미사용수조기환자술후병발증발생솔시사용수조기환자적5.00배.결론 복강경비절제술치료간경화문정맥고압증술후병발증적발생솔고,단주요집중재ASAⅢ급이하환자,ASA분급화수조기적사용여술후병발증적발생유관.
Objective To investigate the postoperative complications after laparoscopic splenectomy for patients with portal hypertension,and analyze the risk factors for postoperative complications.Methods The clinical data of 65 patients with portal hypertension who received laparoscopic splenectomy at the West China Hospital from September 2003 to September 2012 were retrospectively analyzed.The postoperative complications were analyzed using the modified Clavien classification system,and the risk factors for postoperative complications were analyzed.The measurement data and the count data were analyzed using the t test,chi-square test or the Fisher exact probability.The univariate and multivariate analysis were done using the Logistic regression model.Results Twenty-nine patients received hand-assisted laparoscopic splenectomy and 36 received total laparoscopic splenectomy (2 patients were converted to open surgery due to intraoperative bleeding).Sixteen patients had 20 complications.The incidence of postoperative complications of the hand-assisted laparoscopic group was 10.3％ (3/29),which was significantly lower than 38.2％ (13/34) of the total laparoscopic group (x2 =3.90,P ＜ 0.05).According to the modified Clavien classification system,there were 4 patients with grade Ⅰ complication,2 patients with grade Ⅱ complication,8 patients with grade Ⅲ a complication,1 with grade Ⅲ b complication,1 with grade Ⅳa complication,and no Ⅳb or Ⅴ complication was observed.The duration of postoperative hospital stay was (8.4 ± 2.9) days.For patients with grade Ⅱ,Ⅲ and Ⅳ complications,the duration of postoperative hospital stay was (10.1 ± 3.3) days,which was significantly longer than (7.7 ± 2.5) days of patients with grade Ⅰ complication or without complications (t =4.30,P ＜ 0.05).The results of univariate analysis showed that ASA classification and application of hand-associated device were risk factors for postoperative complications (x2=21.60,5.10,P ＜0.05).The results of multivariate analysis showed that ASA grade Ⅲ and non-application of hand-assisted device were independent risk factors for postoperative complications (OR =23.60,4.60,P ＜ 0.05).The incidence of postoperative complications of patients with ASA grade Ⅲ were 17.00 times higher than patients with ASA grade Ⅱ,and the incidence of postoperative complications of patients who received total laparoscopic splenectomy was 5.00 times higher than those who received hand-assisted laparoscopic splenectomy.Conclusions The incidence of postoperative complications is higher in patients with portal hypertension,while the severity of the complications is under ASA grade Ⅲ.ASA classification and application of hand-assisted device are correlated with the incidence of postoperative complications.