急症腹腔镜胆囊切除术中转开腹危险因素的分析

目的:分析术前预测急症腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中转开腹的可能性,以期找到客观、实用、准确率高的预测LC手术难易度的方法,并选择适当的手术方式.方法:回顾分析2005～2009年120例急症LC中38例中转开腹患者的临床资料.从胆囊炎、胆囊结石疾病病理方面提取胆囊...

The clinical analysis of the risk factor of convertion from emergency laparoscopic cholecystectomy to laparotomy

Objective:To investigate the predictive possibility of convertion from emergency laparoscopic cholecystectomy(LC) to open operation to find a practical and effective approach to select appropriate patients for LC.Methods:Medical data of 120 patients who underwent emergency LC from 2005 to 2009 were analyzed retrospectively.From the pathological aspects and of cholecystitis and gallbladder stone disease onset time of cholecystitis,gallbladder triangle anatomical levels,gallbladder wall thickness,gallstone incarceration and gangrenous cholecystitis were extracted as the five factors.With Stata 10.0 statistical analysis software,single factor analysis was made to identify the risk factor of emergency LC convertion to open surgery,multiple logistic regression equation of factor analysis was made to predict the possibility of emergency laparoscopic cholecystectomy convertion to open operation and evaluate the efficiency.Results:One hundred and twenty cases underwent emergency LC,of which 38 cases were converted to open cholecystectomy,conversion rate was 31.67%.Univariate analysis showed that cholecystitis attack>72h,gallbladder triangle indistinct anatomy,gallbladder wall thickness>0.5cm and gangrenous cholecystitis were correlate risk factor of LC conversion to open surgery.Logistic regression analysis showed that cholecystitis attack>72h,gallbladder triangle indistinct anatomy,gallbladder wall thickness>0.5cm and gangrenous cholecystitis were risk factors of LC convertion to open surgery.Logistic regression equation showed predictive efficiency was 0.9519.Conclusions:Cholecystitis attack>72h,gallbladder triangle indistinct anatomy,gallbladder wall thickness>0.5cm,gangrenous cholecystitis are risk factors of conversion to laparotomy.LC patients has the more risk factors,the difficulty of operation is greater,the possibility of conversion to open surgery is higher.Preoperative comprehensive evaluation of risk factor is significant for choosing operative method and decreasing conversion rate,can avoid serious complications of LC.