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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2020, Vol. 09 ›› Issue (03) : 244 -248. doi: 10.3877/cma.j.issn.2095-3232.2020.03.010

所属专题： 文献；

临床研究

肝囊型包虫病胆瘘发生影响因素分析
巴合提·卡力甫1, 孟塬1, 陈伦牮1, 马志刚1, 王锦国1, 宋巍1, 田广磊1, 阿卜来海提·麦提色依提1, 陈雄1,†()   
  1. 1. 830001　乌鲁木齐，新疆维吾尔自治区人民医院肝胆外科
  • 收稿日期:2020-02-26 出版日期:2020-06-10
  • 通信作者: 陈雄
  • 基金资助:
    新疆维吾尔自治区自然科学基金(2018D01C131)

Risk factors of biliary fistula in patients with cystic echinococcosis

Kalifu Baheti1, Yuan Meng1, Lunjian Chen1, Zhigang Ma1, Jingguo Wang1, Wei Song1, Guanglei Tian1, Xiong Chen1,†()   

  1. 1. Department of Hepatobiliary Surgery, Xinjiang Uiger Municipal People's Hospital, Urumqi 830001, China
  • Received:2020-02-26 Published:2020-06-10
  • Corresponding author: Xiong Chen
  • About author:
    Corresponding author: Chen Xiong, Email:
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巴合提·卡力甫, 孟塬, 陈伦牮, 马志刚, 王锦国, 宋巍, 田广磊, 阿卜来海提·麦提色依提, 陈雄. 肝囊型包虫病胆瘘发生影响因素分析[J]. 中华肝脏外科手术学电子杂志, 2020, 09(03): 244-248.

Kalifu Baheti, Yuan Meng, Lunjian Chen, Zhigang Ma, Jingguo Wang, Wei Song, Guanglei Tian, Xiong Chen. Risk factors of biliary fistula in patients with cystic echinococcosis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2020, 09(03): 244-248.

目的

探讨肝囊型包虫病胆瘘（CBF）发生的影响因素。

方法

回顾性分析2016年1月至2018年12月新疆维吾尔自治区人民医院收治的145例肝囊型包虫病患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男70例，女75例；平均年龄（41±18）岁。肝囊型包虫病CBF发生单因素分析采用t检验、秩和检验和χ2检验。多因素Logistic回归分析筛选CBF发生的独立危险因素。

结果

本组患者CBF发生率为27.6%（40/145），其中腹部影像学检查发现12例，术中发现18例，术后发现10例。单因素分析显示，CBF发生与术前黄疸、胆管炎、囊肿数量、肝包虫病类型、手术方式（χ2= 4.56，6.58，7.86，5.67，6.58；P<0.05），ALP、GGT（Z=6.57，4.38；P<0.05），囊肿直径（t=4.78，P<0.05）相关。多因素分析显示，ALP>81 U/L、GGT>50 U/L、囊肿直径>8 cm是CBF发生的独立危险因素（OR=1.112，1.134，1.025；P<0.05）。

结论

术前ALP、GGT和囊肿直径是肝囊型包虫病发生CBF的预测因素。

关键词: 棘球蚴病，肝, 胆瘘, 危险因素
Objective

To investigate the risk factors of cystobiliary fistula (CBF) in patients with cystic echinococcosis.

Methods

Clinical data of 145 patients with cystic echinococcosis admitted to Xinjiang Uiger Municipal People's Hospital from January 2016 to December 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 70 patients were male and 75 female, aged (41±18) years old. Univariate analysis of the incidence of CBF in patients with cystic echinococcosis was performed by t test, rank sum test and Chi-square test. The independent risk factors for CBF were identified by multivariate Logistic regression analysis.

Results

The incidence of CBF in all patients was 27.6% (40/145). The CBF of 12 cases was found by abdominal imaging examination, 18 cases was found during the operation and 10 cases after the operation. Univariate analysis demonstrated that the incidence of CBF was significantly correlated with preoperative jaundice, cholangitis, number of cysts, type of hepatic echinococcosis and surgical methods (χ2= 4.56, 6.58, 7.86, 5.67, 6.58; P<0.05), ALP, GGT (Z=6.57, 4.38; P<0.05), cyst diameter (t=4.78, P<0.05). Multivariate analysis showed that ALP>81 U/L, GGT>50 U/L and cyst diameter>8 cm were the independent risk factors for CBF (OR=1.112, 1.134, 1.025; P<0.05).

Conclusions

Preoperative ALP, GGT and cyst diameter are the risk factors for CBF in patients with cystic echinococcosis.

Key words: Echinococcosis, hepatic, Biliary fistula, Risk factors
表1 CBF发生与肝囊型包虫病患者临床病理学参数的关系
参数 CBF组 无CBF组 统计值 P值
年龄（岁，±s） 40±19 42±21 t=-0.85 0.900
性别（例） ? ? χ2=0.46 0.450
? 男 21 49 ? ?
? 女 19 56 ? ?
腹痛（例） 32 78 χ2=0.54 0.540
黄疸（例） 9 2 χ2=4.56 0.001
胆管炎（例） 7 0 χ2=6.58 0.001
TB[μmol/L，M(QR)] 10.8（1.9～21.3） 6.8（2.0～15.5） Z=0.84 0.100
DB[μmol/L，M(QR)] 9.9（1.9～16.3） 5.3（1.8～7.3） Z=0.84 0.100
AST[U/L，M(QR)] 39.1（11.1～59.2） 27.0（8.1～40.7） Z=0.92 0.800
ALT[U/L，M(QR)] 46.1（10.1～65.2） 35.9（9.1～52.5） Z=0.89 0.700
ALP[U/L，M(QR)] 250（106～601） 81（45～141） Z=6.57 0.001
GGT[U/L，M(QR)] 198（80～400） 50（20～80） Z=4.38 0.001
囊肿数目（例） ? ? χ2=7.86 0.001
? 单发 17 64 ? ?
? 多发 23 41 ? ?
囊肿直径（cm，±s） 16±9 8±4 t=4.78 0.001
囊肿位置（例） ? ? χ2=0.47 0.700
? 中央型 28 52 ? ?
? 周围型 12 53 ? ?
肝包虫病类型（例） ? ? χ2=5.67 0.001
? Ⅰ型 5 25 ? ?
? Ⅱ型 10 41 ? ?
? Ⅲ型 16 33 ? ?
? Ⅳ型 9 6 ? ?
手术类型（例） ? ? χ2=6.58 0.001
? 根治性切除术 7 49 ? ?
? 内囊摘除+外囊大部分切除术 33 56 ? ?
表2 肝囊型包虫病患者CBF发生多因素Logistic回归分析
变量 P值 OR值 95%CI
黄疸 0.285 1.765 0.707～5.830
ALP>81 U/L 0.010 1.025 1.012～1.352
GGT>50 U/L 0.010 1.112 1.025～1.395
囊肿多发 0.192 2.355 0.834～6.835
囊肿直径>8 cm 0.001 1.134 1.025～1.385
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