小儿先天性胆总管囊肿术后出现胆管炎影响因素分析-现代医学

小儿先天性胆总管囊肿术后出现胆管炎影响因素分析

单位：南京医科大学附属儿童医院麻醉手术科, 江苏南京 210000

分类号：R726.5;R657.4

出版年·卷·期（页码）：2024·52·第九期（1353-1357）

摘要：

目的： 探讨小儿先天性胆总管囊肿术后胆管炎影响因素，为预防术后胆管炎的发生提供依据。方法： 回顾性分析2020年9月至2022年9月在我院接受腹腔镜手术的先天性胆总管囊肿患儿127例临床资料，根据术后是否并发胆管炎分为胆管炎组(n＝21)和非胆管炎组(n＝106)。比较两组临床资料，分析先天性胆总管囊肿术后并发胆管炎的独立影响因素，受试者工作特征(ROC)曲线分析独立影响因素对术后并发胆管炎的预测效能。结果： 单因素分析显示，囊肿直径、贫血、合并胆泥结石及术后3 d白蛋白水平与先天性胆总管囊肿患儿术后并发胆管炎有关(P＜0.05)。多因素分析显示，贫血、合并胆泥结石为患儿术后并发胆管炎独立危险因素，术后3 d白蛋白水平为独立保护因素(P＜0.05)。ROC曲线分析显示，3个独立影响因素(贫血、合并胆泥结石、术后3 d白蛋白水平)均对患儿术后并发胆管炎具有一定预测价值，曲线下面积(AUC)分别为0.715、0.744、0.753。结论： 先天性胆总管囊肿患儿术后并发胆管炎与贫血、合并胆泥结石、术后3 d白蛋白水平具有密切关系，且上述指标对术后胆管炎预测价值良好，有助于指导临床开展针对性干预。

Objective: To explore the factors influencing the occurrence of postoperative cholangitis in children with congenital choledochal cysts, and to provide a theoretical basis for preventing the occurrence of postoperative cholangitis. Methods: A retrospective analysis was conducted on the clinical data of 127 children with congenital choledochal cysts who underwent laparoscopic surgery in our hospital from September 2020 to September 2022. Based on whether the postoperative cholangitis occurred, the patients were divided into the cholangitis group(n=21) and the non-cholangitis group(n=106). Clinical data were compared between the two groups to identify independent factors influencing the occurrence of postoperative cholangitis, and the predictive efficacy of these independent factors was evaluated using the receiver operating characteristic(ROC) curve. Results: Univariate analysis indicated that cyst diameter, anemia, the presence of biliary sludge and stones, and albumin levels on postoperative day 3 were associated with the occurrence of postoperative cholangitis in children with congenital choledochal cysts(P<0.05). Multivariate analysis revealed that anemia and the presence of biliary sludge and stones were independent risk factors for postoperative cholangitis, while albumin levels on postoperative day 3 were an independent protective factor(P<0.05). ROC curve analysis demonstrated that the three independent factors had predictive value for postoperative cholangitis, with areas under the curve(AUC) of 0.715, 0.744, and 0.753, respectively. Conclusion: The occurrence of postoperative cholangitis in children with congenital choledochal cysts is closely related to anemia, the presence of biliary sludge and stones, and albumin levels on postoperative day 3. These factors have good predictive value for postoperative cholangitis and can guide targeted clinical interventions.

参考文献：

[1] TAKAGI K,UMEDA Y,YOSHIDA R,et al.Robotic surgery for congenital biliary dilatation using the scope switch technique(with video)[J].Asian J Surg,2023,46(10):4399-4402.
[2] ZHANG M X,CHI S Q,CAO G Q,et al.Comparison of efficacy and safety of robotic surgery and laparoscopic surgery for choledochal cyst in children:a systematic review and proportional meta-analysis[J].Surg Endosc,2023,37(1):31-47.
[3] AMANO H,SHIROTA C,TAINAKA T,et al.Late postoperative complications of congenital biliary dilatation in pediatric patients:a single-center experience of managing complications for over 20 years[J].Surg Today,2021,51(9):1488-1495.
[4] 章开智,陈雨彤,郑泽兵,等.肝脏CD4⁺T细胞、IL-6、IL-8、IL-33的表达与术后胆管炎及黄疸清除的关系研究[J].中华小儿外科杂志,2022,43(12):1088-1094.
[5] BUXBAUM J L,BUITRAGO C,LEE A,et al.ASGE guideline on the management of cholangitis[J].Gastrointest Endosc,2021,94(2):207-221.
[6] ARAFA A,RAGAB M,ELTAGY G H.Laparoscopic hepaticoduodenostomy for choledochal cysts in children<1 year[J].Afr J Paediatr Surg,2022,19(1):36-39.
[7] YAN C,CAO J,ZHENG C,et al.Risk factors and impact on bile leakage in patients with choledochal cysts:a retrospective case-control analysis[J].Updates Surg,2021,73(6):2225-2229.
[8] FERSTL P G,QUECK A,BREMER K,et al.Comparison of short-course antibiotic therapy of 6 or less days with a longer treatment in patients with cholangitis after liver transplantation[J].Transpl Infect Dis,2022,24(4):e13868.
[9] 魏杰,王翔.经内镜逆行胰胆管造影术后并发胰腺炎及胆管炎的危险因素分析[J].中国普通外科杂志,2023,32(9):1415-1420.
[10] MIYATA T,MATSUI D,FUJIWARA Y,et al.Predictive factors for developing acute cholangitis and/or cholecystitis in patients undergoing delayed cholecystectomy:a retrospective study[J].Asian J Surg,2021,44(1):280-285.
[11] KAWAGUCHI Y,TERUI K,KOMATSU S,et al.Usefulness of hepatobiliary scintigraphy for predicting late complications in patients with choledochal cysts[J].Pediatr Surg Int,2022,38(12):1839-1845.
[12] 向强兴,周宇翔,唐湘莲,等.小儿先天性胆总管囊肿腹腔镜手术治疗后并发胆管炎的危险因素分析[J].肝脏,2023,28(7):845-848.
[13] HONDA M,SHIMOJIMA N,MAEDA Y,et al.Factors predicting surgical difficulties in congenital biliary dilatation in pediatric patients[J].Pediatr Surg Int,2023,39(1):79.
[14] 金明均,董亮,杨宏,等.腹腔镜下手术在儿童先天性胆总管扩张中的应用分析[J].河北医科大学学报,2021,42(9):1073-1077.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录