影响腹腔镜胆囊切除术的因素预测

目的：探讨影响腹腔镜胆囊切除手术的因素。方法：对病人的临床表现（包括症状和体征），常规化验检查结果（包括血常规，肝功能，凝血功能等），影像学检查结果，手术后病理检查结果数量化并进行定量对比分析，筛选出影响腹腔镜胆囊切除手术成功的因素，用这些因素建立一个判断式，逐例回代检验确定该判别式的可靠性。结果：从本组628例病人中42例（6．69％）实施中转手术；从年龄、性别、腹痛、WBC等28个因素中筛选出了性别、腹痛、厌油、恶心呕吐、粘连水肿和嗜中性粒细胞比例6个具有显著性差异的相关因素；利用这6个因素确定了需中转手术的判断值＝X1＋X2＋X3＋X4＋X5＋X6，前5项目指标均采用模糊定量，最后1项指标采用实测数据；通过计算得出3．139作为判别值，用该值判断为腹腔镜手术成功者的符合率为82．42％，“误判”为中转手术者103例（17．58％）；判断为中转手术的符合率为69．05％，“漏判”为腹腔镜手术成功者13例（30．95％）；理论判断的总符合率为81．53％。结论：本研究所建立的方法有助于临床医生在手术前对病人进行筛选，可以增加腹腔镜手术成功的把握性。

Study on the Prediction of Factors for Affecting Laparoscopic Cholecystectomy

Objectives To investigated the affecting factors on the Laparoscopic Cholecystectomy(LC). Methods The compared fixed quantity study were carried out on the clinical manifestations (symptoms and signs), routine laboratory testes(WBC,PBC,etc), ultrasonic examination , CT and pathological observation between the LC group and the conversion to open cholecystectomy(OC) group. Selected the affecting factors for LC, the differentiated expression was set up based on these factors. Results Out of 628 cases,42 cases were OC(6.69%). The significant difference was found in sex, abdominalgia, dislike oil, nausea and vomiting, adhere and edema, neutrophil in blood between the LC and OC. The differentiated formula was X1+X2+X3+X4+X5+X6. The differentiated value was 3.139. According to this value, the suit-ratio was 82.42% in the LC, 69.05% in the OC. The total suit-rate was 81.53%. Conclusion The differentiated expression in the study was helpful for the surgeon to select the appropriate patients of LC.