腹腔镜胆囊切除术转开腹的危险因素Logistic分析

目的 探讨腹腔镜胆囊切除术转开腹的主要危险因素.方法 回顾分析2009～2011年45例腹腔镜胆囊切除术中转开腹患者的临床资料,根据患者临床症状、体征以及临床指标对中转开腹的主要危险因素进行分析.结果 多因素Logistic回归结果显示,患者的胆囊壁厚度、胆囊炎发作次数、左上腹肌紧张程度、胆囊炎发作到手术时间、血清总胆红素、胆囊三角的清晰度以及墨菲征阳性程度均为胆囊切除术中转开腹的危险因素.结论 手术前对上述危险因素进行综合评估对成功施行腹腔镜胆囊切除术具有重要的临床指导意义.

Risk factors for conversion of laparoscopic cholecystectomy to open cholecystectomy: 1:3 matched case-control study

Objective To analyze the risk factors contributing to the decision to convert laparoscopic to open cholecystectomy.Methods Clinical data of 70 cases of laparoscopic cholecystectomy to open cholecystectomy and 210 cases of successful laparoscopic cholecystectomy(control group) were compared.Results Single factor analysis showed that the number of patients with age ≥ 60 years,acute cholecystitis,thick gallbladder wall,wide common bile duct and elevated total bilirubin in laparotomy group was significantly higher than that in control group(P<0.01).The male proportion of open group was higher than that of the successful group(P<0.05).Multivariate conditional logistic regression analysis showed: age≥60years;male;acute cholecystitis;gallbladder wall ≥4 mm;common bile duct diameter ≥ 8 mm and total bilirubin >17.1 mol/L were risk factors for laparoscopic conversion to open cholecystectomy.Conclusion Patients with risk factors for conversion to open cholecystectomy should avoid undergoing laparoscopic cholecystectomy or the laparoscopic operation be performed by experienced clinicians.