Analysis Of The Risk Factors Of Postoperative Complications In The Treatment Of Complex Intrahepatic Cholelithiasis By Percutaneous Transhepatic Cholangioscopy

Objective:To evaluate the risk factors of postoperative complications in patients with complex intrahepatic cholelithiasis after percutaneous transhepatic cholangioscopy and to estimate the risk of operation.Methods:A retrospective analysis was made of the clinical data of 81patients admitted to the Second Affiliated Hospital of Chongqing Medical University from January 2017 to November 2019 who underwent percutaneous endoscopic lithotomy.37 patients with postoperative acute cholangitis or bile duct bleeding were set as the experimental group,while44 patients without postoperative complications were set as the control group.The indicators included in the statistical study included age of patients in the two groups,biliary stenosis,multiple drug resistance of bile culture bacteria,preoperative serological indicators,operative time,intraoperative lithotripsy and other 17 items.Statistical methods were used to conductχ~2test or t-test for the above indicators,and Logistic multivariate regression analysis was carried out for the indicators with P<0.1 in the analysis.Results:In this study,there were 37 cases of postoperative complications in 81 patients,including 22 cases of acute cholangitis(27.16%),11 cases of biliary hemorrhage(13.58%),and 4 cases of acute cholangitis complicated with biliary hemorrhage(4.94%).No patients died of complications.Single factor analysis results show that:In two groups of patients age,bile cultures multi-resistant,operation time,intraoperative gravel has statistically significant(P=0.047,0.019,0.001,0.004)are the risk factors influencing the postoperative complications,according to theα<0.1 standard,the above four variables and biliary stricture,preoperative bilirubin(P=0.06,0.071)for binary Logistic regression analysis,multiple factors results in two groups of patients in the biliary stricture and biliary multiple drug-resistant bacteria,operation time,intraoperative gravel statistical differences(OR=0.133,0.175,1.016,0.102;P=0.012,0.015,0.004,0.001).Conclusion:Bile duct stenosis,multiple drug resistance of bile culture bacteria,operative time and intraoperative lithotripsy were independent risk factors for the total complications of surgery.Patients with biliary stenosis and obstruction or multidrug-resistant biliary tract infection,as well as prolonged operative time and intraoperative lithotripsy may increase the risk of PTCS surgery.The surgeon should accurately grasp the indications of the operation,make full preparations before the operation,actively treat the infection,optimize the operation process,stage the operation,and adopt more advanced equipment to reduce the complications.