老年胆总管结石患者行腹腔镜胆总管探查术围术期并发症的危险因素分析OACSTPCD

Objective:To analyze the perioperative complications and risk factors of laparoscopic common bile duct exploration(LCBDE)in the treatment of elderly patients with choledocholithiasis.Methods:A retrospective case-control study was used to collect the clinical data of 137 elderly patients with choledocholithiasis who underwent LCBDE from Jan.2021 to Jul.2023,and to observe the occurrence of perioperative complications using Clavien-Dindo grading.The risk factors of grade Ⅱ and above complications were ana-lyzed by univariate and multivariate logistic regression,and receiver operating characteristic curves were drawn.Results:Perioperative complications occurred in 63 patient(45.99%),Clavien-Dindo grading was grade Ⅰ 31.39%(43/137),grade Ⅱ 10.95%(15/147),Grade Ⅲa 2.92%(4/137),Grade Ⅲb 0.73%(1/137).The results of multivariate logistic regression analysis showed that the Charlson comorbidity index)≥4(OR=4.520,95%CI=1.141～17.912,P=0.032),American society of anesthesiologists physical status≥Ⅲ(OR=4.330,95%CI=1.014～18.496,P=0.048),and concomitant moderate to severe acute cholangitis(OR=9.531,95%CI=2.410～37.696,P=0.001)were independent risk factors for perioperative complications.The area under the curve of the three risk factors and the combined prediction probability was 0.766,0.761,0.748 and 0.864,respectively.Conclusions:Charlson comorbidity index≥4,American society of anesthesiologists physical status≥Ⅲ,and concomitant moderate to severe acute cholangitis are independent risk factors for perioperative complications after LCBDE in elderly patients with choledocholithiasis.Preoperative evalu-ation,recognition of these three risk factors,and early intervention should be fully valued.