腹腔镜胆囊切除术并发症相关因素分析

目的 探讨导致腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)并发症发生的危险因素。方法 回顾分析我院自1991年3月-2003年6月间11974例腹腔镜胆囊切除术患者中发生并发症的临床资料,采用X~2检验和Logistic回归方法对可能导致腹腔镜胆囊切除术并发症发生的15个临床病理相关因素,进行多因素回归分析。结果 本组资料LC术后并发症的发生率为1.896％(227/11 974),中转手术率为2.386％(286/11 974),其中因发生并发症而中转开腹65例,占22.727％(65/286)。Logistic回归分析显示,按作用强度,Calot三角粘连、病期、手术经验、胆囊壁厚度(B超)、胆囊与周围粘连依次为导致腹腔镜胆囊切除术并发症发生的主要危险因素。结论 加强医师的腹腔镜技术培训,正确掌握LC相关危险因素是提高LC手术成功率的关键,正确掌握中转开腹的时机及开腹后处理方法,是降低LC手术严重并发症发生和死亡的有效措施。

Analysis of risk factors for to complications after laparoscopic cholecystectomy

Objective To investigate the risk factors for to complications in patients urolergoing laparoscopic cholecystectomy. Methods Clinical data from 11 974 patients with laparoscopic cholecystectomy from Mar. 1991 to June 2003 was collected and analyzed retrospectively. Fifteen clinical factors were recruited for analysis their relationship relation with complications of patients in laparoscopic cholecystectomy. Date was analyzed by x2 test and Logistic regression. Results The rate of postoperative complication was 1.896% , the conversion rate in case of difficult laparoscopic cholecystectomy was 2.386% , Logistic regression analysis revealed that calot triangle adhesion, stadium, operative skill, gallbladder wall thickness, adhesion between gallbladder and abdominal cavity were significant factors for complications of patients with laparoscopic cholecystectomy. Conclusions Complications of laparoscopic cholecystectomy could be prevented by strict training, serious operative procedures, immediate discovery and proper treatment. It s important that surgeons predominate correctly opportunity and management of patients for reducing postoperative complications.