Abstract
Objective To analyze the risk factors of new choledocholithiasis in patients with severe acute cholecysti-tis after ultrasound-guided percutaneous transhepatic gallbladder drainage(PTGD).Methods Totally 140 patients with severe acute cholecystitis who received PTGD were followed up for at least 2 months after PTGD,including 26 patients with new choledocholithiasis(new group)and 114 patients without new choledocholithiasis(control group).The general information[gender,age,drinking history,body mass index(BMI),history of cholecystitis,preoperative anti-inflamma-tory therapy,fever,chills,and underlying diseases],and the relevant indexes of preoperative laboratory examination[white blood cell count,neutrophil percentage,alanine aminotransferase(ALT),aspartate aminotransferase(AST),glu-tamyl transpeptide,alkaline phosphatase,C-reactive protein,total bilirubin,direct bilirubin,platelet count,activated partial thrombin time(APTT)],preoperative imaging indicators[gallbladder wall thickness,common bile duct diameter,single/multiple gallstones,gallstone characteristics,abnormal union of the cystic duct into the common bile duct,abnormal pancreatitis and bile duct confluence,Mirizzi syndrome,and peribile effusion]and intubation time were compared between these two groups.Multifactor Logistics regression was used to analyze the risk factors of new choledocholithiasis in patients with severe acute cholecystitis after PTGD.Results There were no significant differences in the relevant indicators be-tween the two groups(all P>0.05).There were no significant differences in the percentage of leukocytes,neutrophils,ALT,AST,glutamyltranspeptides,alkaline phosphatase,C-reactive protein,total bilirubin,direct bilirubin or APTT be-tween the two groups before surgery(all P>0.05).The platelet count in the new group was lower than that in the control group(P<0.05).The proportions of multiple cholecystolithiasis,abnormal union of the cystic duct into the common bile duct and cholecystectomy diameter in the new group were higher than those in the control group(all P<0.05),and there was no significant difference in gallbladder wall thickness between the two groups(P>0.05).The intubation time in the new group and the control group was(24.69±2.32)and(16.75±4.79)d,respectively,and the intubation time in the new group was longer than that in the control group(P<0.05).The results of multi-factor Logistics regression analysis showed that increased multiple cholecystolithiasis(OR=9.429,95%CI:1.904-46.694)and abnormal union of the cystic duct into the common bile duct(OR=11.282,95%CI:2.698-47.186),and the increased diameter of common bile duct(OR=1.590,95%CI:1.246-2.030),and the prolonged intubation time(OR=1.677,95%CI:1.267-2.220)were inde-pendent risk factors for new choledocholithiasis after PTGD in patients with severe acute cholecystitis(all P<0.05),while decreased platelet count was not an independent risk factor for new choledocholithiasis after PTGD in patients with severe acute cholecystitis(P>0.05).Conclusions Multiple cholecystolithiasis,abnormal union of the cystic duct into the com-mon bile duct,choledochectasia and long intubation time are associated with new cholecystolithiasis after PTGD in patients with severe acute cholecystitis.关键词
重度急性胆囊炎/胆囊穿刺置管引流术/胆总管结石/多发性胆囊结石/胆囊管汇入胆总管异常/胆总管扩张/带管时间Key words
acute cholecystitis/gallbladder puncture and drainage/choledocholithiasis/multiple gallstone/abnormal union of the cystic duct into the common bile duct/choledochectasia/intubation time分类
临床医学
