腹腔镜胆囊切除术中转开腹危险因素的探讨
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摘要
目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy LC)中转开腹的危险因素。方法:回顾性分析2006年3月至2008年6月收治的1628例LC的临床资料,用χ2检验进行单因素分析,再进行logistic多元回归分析,筛选影响LC转开腹手术的独立的危险因素。结果:本组1628例病人中1586例LC成功,42例中转开腹(2.58%)。单因素χ2分析结果显示LC失败的危险因素有男性、高龄(>65岁)、肝硬化、胆囊壁增厚(>4cm)、急性胆囊炎发作时间(>72h)、上腹部手术史、白细胞增高、胆囊颈部结石嵌顿、胰腺炎病史、糖尿病为中转开腹的主要危险因素(P<0.05)。多因素logistic回归分析显示男性、肝硬化、胆囊壁增厚(>4cm)、白细胞增高、急性胆囊炎发作时间(>72h)、上腹部手术史、胆囊颈部结石嵌顿、胰腺炎病史、糖尿病是影响腹腔镜中转开腹率的独立危险因素(OR>1)。结论:从男性、肝硬化、胆囊壁增厚(>4cm)、白细胞增高、急性胆囊炎发作时间(>72h)、上腹部手术史、胆囊颈部结石嵌顿、胰腺炎病史、糖尿病9种危险因素,可以预测中转的概率。术前对病人进行全面的评估,正确掌握中转开腹的时机是降低LC手术严重并发症发生的有效措施。
Objective: To study the risk factors on laparoscopic cholecystectomy (LC) conversion to open cholecystectomy (OC). Methods: Clinical data of 1628 patients undergoing LC from Mar. 2006 to Jun. 2008 were collected and analyzed retrospectively. Single factor analysis was performed byχ2. Multiple factor analysis with logistic regression was performed for the risk factors. The independent risk factors that affect the conversion rate were selected. Results: It was found that among the 1628 cases of cholecystitis, 1586 underwent laparoscopic cholecystectomy successfully and 42(2.58%) had conversion to open cholecystectomy. Univariate analysis byχ2 showed that male gender, Age>65, cirrhosis, thickened gallbladder wall(>4cm), Duration of acute cholecystectomy more than 72h, previous upper abdom operation history, high lever of leukocyte count, stone incarceration in cholecystic neck, pancreatitis case history and diabetes mellitus were significantly correlated with the rate of conversion to open procedure(P<0.05). Multivariate analysis with logistic revealed that male gender, cirrhosis, thickened gallbladder wall(>4cm), Duration of acute cholecystectomy more than 72h, previous upper abdom operation history, high lever of leukocyte count, stone incarceration in cholecystic neck, pancreatitis case history and diabetes mellitus were independent risk factors for conversion from laparoscopic cholecystectomy to open surgery(OR>1). Conclusion: The conversion rate can be predicted easily by this nine risk factors: male gender, cirrhosis, thickened gallbladder wall(>4cm), Duration of acute cholecystectomy more than 72h, previous upper abdom operation history, high lever of leukocyte count, stone incarceration in cholecystic neck, pancreatitis case history and diabetes mellitus. Evaluati completely the patients of LC before operation. Complications can be prevented by strictly following protocol, and timely shifting to open surgery.
Objective: To study the risk factors on laparoscopic cholecystectomy (LC) conversion to open cholecystectomy (OC). Methods: Clinical data of 1628 patients undergoing LC from Mar. 2006 to Jun. 2008 were collected and analyzed retrospectively. Single factor analysis was performed byχ2. Multiple factor analysis with logistic regression was performed for the risk factors. The independent risk factors that affect the conversion rate were selected. Results: It was found that among the 1628 cases of cholecystitis, 1586 underwent laparoscopic cholecystectomy successfully and 42(2.58%) had conversion to open cholecystectomy. Univariate analysis byχ2 showed that male gender, Age>65, cirrhosis, thickened gallbladder wall(>4cm), Duration of acute cholecystectomy more than 72h, previous upper abdom operation history, high lever of leukocyte count, stone incarceration in cholecystic neck, pancreatitis case history and diabetes mellitus were significantly correlated with the rate of conversion to open procedure(P<0.05). Multivariate analysis with logistic revealed that male gender, cirrhosis, thickened gallbladder wall(>4cm), Duration of acute cholecystectomy more than 72h, previous upper abdom operation history, high lever of leukocyte count, stone incarceration in cholecystic neck, pancreatitis case history and diabetes mellitus were independent risk factors for conversion from laparoscopic cholecystectomy to open surgery(OR>1). Conclusion: The conversion rate can be predicted easily by this nine risk factors: male gender, cirrhosis, thickened gallbladder wall(>4cm), Duration of acute cholecystectomy more than 72h, previous upper abdom operation history, high lever of leukocyte count, stone incarceration in cholecystic neck, pancreatitis case history and diabetes mellitus. Evaluati completely the patients of LC before operation. Complications can be prevented by strictly following protocol, and timely shifting to open surgery.
引文
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