腹腔镜胆囊切除术中转开腹的危险因素分析

目的:分析腹腔镜胆囊切除术中转开腹的原因及相关危险因素,为外科医生的临床决策提供参考。方法:回顾分析3 476例腹腔镜胆囊切除术患者的临床资料,采用单因素分析及多因素logistic回归分析,探讨影响中转开腹的危险因素,并用SPSS 13.0绘制历年中转开腹率趋势图。结果:3 476例患者中,163例中转开腹,中转开腹率为4.7%;中转开腹组与腹腔镜组手术时间、术中出血量、术后住院时间、术后排气时间差异有统计学意义(P<0.05);胆囊粘连严重、胆囊三角处理困难是中转开腹的主要原因,占所有因素的57.1%;单因素分析结果显示:肥胖、手术经验、腹部手术史、胆囊炎反复发作史、胆囊壁厚度、WBC计数与腹腔镜胆囊切除术中转开腹相关(P<0.05);多因素分析结果显示:腹部手术史、肥胖、胆囊炎反复发作史、手术经验、胆囊壁厚度是影响腹腔镜胆囊切除手术中转开腹的独立危险因素(P<0.05)。结论:术前正确评估腹腔镜胆囊切除术中转开腹的相关危险因素,可为外科医生术中决策提供一定的参考,并可减少手术并发症。

Risk factors of laparoscopic cholecystectomy converted to laparotomy

Objective： The aim of this study is to analyze the reasons and risk factors of intraoperative conversion from laparoscopic cholecystectomy to open cholecystectomy,and provide a reference for surgeons. Methods： Retrospective analysis was performed on the clinical data of 3 476 patients,who underwent laparoscopic cholecystectomy. Risk factors were evaluated by univariate analysis and logistic multiple regression analysis. A trend graph of conversion rate over the years was drawn by SPSS 13. 0. Results： In the 3 476 patients,163 of them were converted to open cholecystectomy,the overall conversion rate was 4. 7%; The operative time,blood loss,postoperative hospital stay and exsufflation time showed significant differences between conversion and laparoscopy group（ P〈 0. 05）;The most common reason for conversion was adhesions and difficult dissection at the Calot triangle,accounting for 57. 1% of all the factors. The factors affecting conversion rate which were found to be significant by univariate analysis included： obesity,experience of operators,history of abdominal surgery,history of repeated acute cholecystitis,gallbladder wall thickness,white blood cell count（ P〈 0. 05）. The independent risk factors of laparoscopic cholecystectomy converted to open surgery which were found by multiple-factors included previous abdominal surgery,obesity,history of repeated cholecystitis,experience of operators,gallbladder wall thickness（ P〈 0. 05）. Conclusions： Correct assessment of risk factors for conversion of laparoscopic cholecystectomy to laparotomy can provide a reference for surgeons,and reduce complications.