CAJ | 학술논문

目的通过螺旋CT检查胆总管探查引流术后T管窦道的形成,探讨影响窦道形成的相关因素.方法回顾性分析2011年5月至2013年12月右江民族医学院附属医院收治的465例行胆总管探查引流术患者的临床资料,术后2周行T管造影检查,判断有无胆道残留结石及狭窄,行螺旋CT检查T管窦道是否形成.选择患者性别、年龄、Alb、C反应蛋白、ALT、TBil、Hb、手术方式、T管周围积液、再次手术、糖尿病11个可能会影响窦道形成的因素进行分析.单因素分析采用x2检验,多因素分析采用Logistic回归.结果 465例患者T管造影均通畅,且无残留结石;CT检查发现397例患者术后2周形成完整窦道,即行T管拔除.对于窦道形成不完整或未形成的患者,术后4周复查CT判断窦道形成后拔除T管.所有患者均无胆汁漏发生,痊愈出院.单因素分析结果显示:Alb、手术方式、T管周围积液、糖尿病是影响T管窦道形成的因素(x2=50.750,7.671,19.022,15.373,P＜0.05);多因素分析结果显示:Alb＜ 30 g/L,腹腔镜手术、T管周围积液、糖尿病是影响T管窦道形成的独立危险因素(OR=1.135,0.493,0.262,0.363;95％CI:1.061 ～1.214,0.280～ 0.865,0.104～0.658,0.156 ～0.843,P＜0.05).结论胆总管探查引流术后2周可通过CT检查判断T管窦道形成情况而决定是否拔除T管.Alb＜ 30 g/L、腹腔镜手术、T管周围积液、糖尿病是影响T管窦道形成的独立危险因素.
목적 통과라선CT검사담총관탐사인류술후T관두도적형성,탐토영향두도형성적상관인소.방법 회고성분석2011년5월지2013년12월우강민족의학원부속의원수치적465례행담총관탐사인류술환자적림상자료,술후2주행T관조영검사,판단유무담도잔류결석급협착,행라선CT검사T관두도시부형성.선택환자성별、년령、Alb、C반응단백、ALT、TBil、Hb、수술방식、T관주위적액、재차수술、당뇨병11개가능회영향두도형성적인소진행분석.단인소분석채용x2검험,다인소분석채용Logistic회귀.결과 465례환자T관조영균통창,차무잔류결석;CT검사발현397례환자술후2주형성완정두도,즉행T관발제.대우두도형성불완정혹미형성적환자,술후4주복사CT판단두도형성후발제T관.소유환자균무담즙루발생,전유출원.단인소분석결과현시:Alb、수술방식、T관주위적액、당뇨병시영향T관두도형성적인소(x2=50.750,7.671,19.022,15.373,P＜0.05);다인소분석결과현시:Alb＜ 30 g/L,복강경수술、T관주위적액、당뇨병시영향T관두도형성적독립위험인소(OR=1.135,0.493,0.262,0.363;95％CI:1.061 ～1.214,0.280～ 0.865,0.104～0.658,0.156 ～0.843,P＜0.05).결론 담총관탐사인류술후2주가통과CT검사판단T관두도형성정황이결정시부발제T관.Alb＜ 30 g/L、복강경수술、T관주위적액、당뇨병시영향T관두도형성적독립위험인소.
Objective To explore the risk factors affecting T-tube sinus tract formation after common bile duct exploration and T-tube drainage by spiral computed tomography (SCT)examination.Methods The clinical data of 465 patients undergoing common bile duct exploration and T-tube drainage at the Affiliated Hospital of Youjiang Medical College for Nationalities from May 2011 to December 2013 were retrospectively analyzed.The residual stones and biliary stricture were detected by T-tube cholangiography,and the T-tube sinus tract formation in all the patients was detected by SCT examination at postoperative week 2.The factors affecting sinus tract formation were analyzed,including gender,age,albumin (Alb),C-reactive protein,alanine transaminase (ALT),total bilirubin (TBil),hemoglobin (Hb),surgical method,effusion around T tube,reoperation,diabetes.Univariate analysis was done using the chi-square test.Multivariate analysis was done using the Logistic regression.Results T-tubes of 465 patients were clear without residual stones.T-tube in the 397 patients was removed when the sinus tract formation was confirmed by CT examination at postoperative week 2.T-tubes in other patients were removed when the sinus tract formation was detected by CT reexamination at postoperative week 4.In univariate analysis,Alb,surgery method,effusion around T-tube and diabetes were important factors affecting T-tube sinus tract formation (x2 =50.750,7.671,19.022,15.373,P ＜ 0.05).Alb ＜ 30 g/L,laparoscopic surgery,effusion around T-tube and diabetes were independent risk factors affecting T-tube sinus tract formation in multivariate analysis [Odds ratio =1.135,0.493,0.262,0.363; 95％ confidence interval:1.061-1.214,0.280-0.865,0.104-0.658,0.156-0.843,P ＜ 0.05].Conclusions The T-tube removal is determined according to the sinus tract formation by CT examination at week 2 after common bile duct exploration and T-tube drainage.Alb ＜ 30 g/L,laparoscopic surgery,effusion around T-tube and diabetes are independent risk factors affecting T-tube sinus tract formation.