腹腔镜胆囊切除术, 胆道镜, 胆道造影, 术后并发症, 危险因素

Objective To investigate the application value of choledochoscopy combined with intraoperative cholangiography (IOC) in difficult laparoscopic cholecystectomy (LC), and to analyze the related factors affecting the occurrence of postoperative complications. Methods A total of 186 patients with difficult LC admitted to Wenzhou Hospital of Intergrated Traditional Chinese and Western Medicine from Jun. 2019 to Sep. 2020 were randomly divided into the control group (n=93) and the observation group (n=93). Patients in control group were treated with conventional difficult LC, and patients in observation group were treated with choledochoscopy combined with IOC in LC. Ratio of bile duct injury, operation time, intraoperative blood loss, time of hospitalization, conversion rate of laparotomy and complications 3 months after operation were compared between the two groups. Univariate analysis and multivariate Logistic regression models were employed to analyze the related factors of postoperative complications. Results There were statistical differences between two groups in terms of operation time [(36.38±4.16)min vs (52.24±8.46)min], intraoperative blood loss [(67.35±6.22)mL vs (86.64±7.69)mL], hospitalization time [(5.72±0.36)d vs (8.45±1.42)d], conversion rate [0 vs 8.60% (8/93)], and the total incidence of postoperative complications [4.30% (4/93) vs 15.05% (14/93)] were all statistically significant (P<0.05), indicators in observation group were all lower than those in control group. Multivariate Logistic analysis showed that age>60 years old (OR 2.128, 95%CI 1.395~2.902), diabetes mellitus (OR 2.526, 95%CI 1.682~3.427), operation time ≥40 min (OR 2.318, 95%CI 1.879~2.836), intraoperative blood loss ≥70 mL (OR 2.418, 95%CI 1.389~3.523), and non-intraoperative cholangiography (OR 3.967, 95%CI 2.184~4.853) were independent factors of postoperative complications. Conclusion For difficult LC, choledochoscopy combined with IOC can reduce bile duct injury, operation time, intraoperative blood loss, hospitalization time and conversion laparotomy rate, and postoperative complications. Complications after difficult LC are related to patient’s age, whether or not complicated with diabetes, operation time, intraoperative blood loss, and intraoperative cholangiography

laparoscopic cholecystectomy, choledochoscopy, cholangiography, postoperative compications, risk factors