影响腹腔镜胆囊手术转开腹手术危险因素分析

目的分析腹腔镜胆囊切除转开腹手术的相关危险因子。方法对1998年1月至2007年12月在上海新华医院普外科进行腹腔镜胆囊手术的2550例患者的临床病例资料进行回顾性分析。结果2550例患者中，255例转为开腹术（10．00％）。其中，高龄、男性、体重超重、有急性胆囊炎史、有上腹部手术史、糖化血红蛋白高，以及低年资医师主刀等是中转开腹的危险因素。慢性肝病不是危险因素。结论丰富的手术经验是避免中转开腹的重要因素。此外，术前仔细分析患者病史及检查结果并以此规划手术细节，有助于降低中转开腹的几率。

Analysis on the risk factors of laparoscopic cholecystectomy con- version to laparoscopic cholecystectomy

Objective To investigate the risk factors of laparoscopic cholecystectomy conversion to laparoscopic cholecystectomy. Methods The clinical and follow - up data of 2550 cases from January 1998 to December 2007 was analyzed retrospectively by the grouped case - control study. Multivariable logistic regression was used to evaluate the factors. Results Male, advanced age, overweight, history of acute cholecystitis, history of upper abdominal surgery, high glycosylated hemoglobin, increased white blood cell count and experience of surgeon were related with open cholecystectomy by multivariable analysis. Chronic liver disease was not a risk factor. Conclusions Surgical experince is an important factor, besides, detailed planning for operation through careful analysis of patient's history and results of preoperative examinations way help reduce the convertion rate of open cholecystectomy.