腹腔镜肝肿瘤切除中转开腹的影响因素分析

目的探究腹腔镜肝肿瘤切除中转开腹的影响因素,为患者术式选择提供参考。方法回顾分析2015年12月至2018年11月于宁波市医疗中心李惠利医院东部院区行腹腔镜肝肿瘤切除术的222例患者资料,其中男性146例,女性76例,平均年龄58.1岁。按术中是否中转开腹分为中转开腹组(n=24)和腹腔镜组(n=198)。采用χ2检验筛选术中中转开腹的相关因素,采用logistic回归模型进行多因素分析,筛选中转开腹的独立危险因素。结果所有患者中转开腹24例,中转率10.8%(24/222)。单因素分析显示,高血压、腹部手术史、肝硬化、肿瘤位于后上段和大范围肝切除与术中中转有关(均P<0.05)。多因素分析,肝硬化(OR=2.611,95%CI:1.018~6.701)、肿瘤位于后上段(OR=6.115,95%CI:2.207~16.941)和大范围肝切除(OR=3.361,95%CI:1.150~9.825)是腹腔镜肝肿瘤切除中转开腹的独立危险因素(均P<0.05)。结论肝硬化、肿瘤位于后上段或拟行大范围肝切除的肝肿瘤患者在接受腹腔镜肝切除时发生计划外中转开腹的风险更高。

Influencing factors in predicting conversion of laparoscopic liver tumor resection to open surgery

Objective To study the influencing factors in predicting conversion of laparoscopic liver tumor resection to open surgery to provide references for selection of patients for laparoscopic hepatectomy.Methods The clinical data of 222 patients who were planned to undergo laparoscopic liver tumor resection at Ningbo Medical Center Lihuili Hospital from December 2015 to November 2018 were analyzed retrospectively.There were 146 males and 76 females,with an average age of 58.1 years.These patients were divided into the conversion group(n=24)and the laparscopic group(n=198)according to whether intraoperative conversion to open surgery was carried out.Chi-square test was used to evaluate relevant factors of conversion.Logistic regression analysis was used for multivariate analysis and to find out independent risk factors of conversion.Results The conversion rate was 10.8%(24/222).Univariate analysis showed that hypertension,history of abdominal surgery,liver cirrhosis,tumors located at posterosuperior segments and major liver resection were significantly associated with conversion(all P<0.05).Multivariate analysis showed that the risk factors which were independently associated with conversion were liver cirrhosis(OR=2.611,95%CI:1.018-6.701),tumors located at posterosuperior segments(OR=6.115,95%CI:2.207-16.941),and major liver resection(OR=3.361,95%CI:1.150-9.825)(all P<0.05).Conclusion Patients who were planned for laparoscopic liver tumor resection with liver cirrhosis,tumors at posterosuperior segments or major liver resection were at higher risks of conversion to open surgery.