老年胆囊结石患者胆囊切除术后的生活质量及其影响因素

Quality of life in elderly patients with gallstones after cholecystectomy and its influencing factors

【摘要】目的 探讨老年胆囊结石患者胆囊切除术后的生活质量及其影响因素。方法 回顾性分析2022年1月至2023年1月于南京中医药大学南通附属医院行胆囊切除术治疗的130例老年胆囊结石患者的临床资料,均在术后1个月采用胃肠道生活质量指数(GIQLI)评估患者生活质量情况。GIQLI得分＜121分者纳入观察组(n=37),GIQLI得分≥121分者纳入对照组(n=93)。采用SPSS 20.0统计软件对数据进行统计分析。根据数据类型,分别采用t检验或χ²检验进行组间比较。采用多因素logistic回归模型分析老年胆囊结石患者胆囊切除术后1个月生活质量情况的影响因素。结果 两组患者结石特性、插管次数、胆囊壁厚度、周围器官粘连、Calot三角粘连、手术方式及并发症情况比较,差异有统计学意义(χ²=10.569、10.013、4.134、4.767、5.121、8.353、8.190,P＜0.05)。多因素logistic回归分析发现泥沙状结石(OR=3.916,95%CI 1.157～13.252)、插管次数＞3次(OR=4.632,95%CI 1.143～18.773)、胆囊壁厚度＞5mm(OR=4.125,95%CI 1.071～15.887)、周围器官粘连(OR=3.854,95%CI 1.154～12.864)、Calot三角粘连(OR=4.609,95%CI 1.237～17.170)及术后并发症(OR=4.108,95%CI 1.214～13.903)是影响老年胆囊结石患者胆囊切除术后生活质量的独立危险因素(P＜0.05)。结论 泥沙状结石、插管次数、胆囊壁厚度、周围器官粘连、Calot三角粘连及术后并发症与患者术后生活质量不佳之间存在显著关联,术前需对以上因素进行全面评估并给予针对性措施,以改善患者术后生活质量。

基金项目:江苏省中医药科技计划重点项目(ZD202231)；南通市基础科学研究和社会民生科技计划项目(MSZ2022034)

【Abstract】Objective To investigate the quality of life (QoL) in elderly patients with gallstones after cholecystectomy and its influencing factors. Methods A retrospective analysis was conducted of the clinical data of 130 elderly patients with gallstones who underwent cholecystectomy in Nantong Hospital Affiliated to Nanjing University of Chinese Medicine from January 2022 to January 2023. Gastrointestinal quality of life index (GIQLI) was used to assess the QoL of all patients one month after surgery. Patients with GIQLI score < 121 points were included in the observation group (n=37), and those with GIQLI score ≥121 points were included in the control group (n=93). SPSS 20.0 was used for statistical analysis of the data. According to the data type, the t test orχ² test was used for comparison between groups. Multivariate logistic regression model was used to analyze the influencing factors of QoL one month after cholecystectomy. Results There were significant differences between the two groups in calculus characteristics, number of catheter insertions, gallbladder wall thickness, adhesion of the surrounding organs, Calot triangle adhesion, operative methods, and complications (χ²=10.569,10.013,4.134,4.767,5.121,8.353,8.190, P<0.05). Multivariate logistic regression analysis found silty calculi (OR=3.916, 95%CI 1.157-13.252), number of catheter insertions > 3 (OR=4.632,95%CI 1.143-18.773), gallbladder wall thickness > 5 mm (OR=4.125,95%CI 1.071-15.887), adhesion of surrounding organs (OR=3.854,95%CI 1.154-12.864), Calot triangle adhesion (OR=4.609,95%CI 1.237-17.170), and postoperative complications (OR=4.108,95%CI 1.214-13.903) were an independent risk factor for QoL in elderly patients with cholecystectomy (P<0.05). Conclusion Silty calculi, number of catheter insertions, gallbladder wall thickness, adhesion of the surrounding organs, Calot triangle adhesion, and postoperative complications are significantly associated with poor quality of life in patients after cholecystectomy. Preoperative comprehensive evaluation of these factors and targeted measures should be taken to improve their postoperative quality of life.

This work was supported by the Key Project of Jiangsu Science and Technology Program in Traditional Chinese Medicine (ZD202231)and the Plan Project of Nantong Basic Science Research and Social & Livelihood Science and Technology (MSZ2022034).