508例急性胆囊炎行腹腔镜胆囊切除术的量化手术指征探讨

Study in the quantiatative operative indication of laparoscopic cholesystectomy in acute cholesystitis

目的在术前筛选高难度的手术病人,建立急性胆囊炎行成功LC的预测模式,并确立一个简单易行的量化手术指标。方法通过回顾性和前瞻性研究,对急性胆囊炎行LC的危险因素进行统计学处理,并制定术前的量化指征。结果作为急性胆囊炎选择手术方案的标准。本文得出的危险因素按危险值大小,分别是技术因素,胆囊大小,胆囊壁厚度,上腹部手术史。对508例急性胆囊炎病人按照PRFSS评分标准术前判定LC或OC,LC成功率明显上升(91.79%上升至96.67%),中转开腹率从4.82%下降至1.67%,平均住院日下降了2.73天(37.14%),经检验P<0.05,差异有显著性。结论急性胆囊炎腹腔镜切除术危险因素术前评分系统,由于获取临床资料方便,可操作性强,可显著减少LC的手术并发症和中转开腹率,具有很大优越性。

[Objective] To choose most difficult patients before operation to establish predictive model for AC undergoing LC, as well as to set a simple applicable preoperation risk factor scoring system （PRFSS）. [Methods] Through retrospective and predictive research, statistical management for risk factor of AC undergoing LC was made to set PRESS. [Result] As criterion for AC to choose operation method, risk factor according to the risk value were： technical factor, size of gallbladder, thickness of gallbladder wall, and history of upper abdominal surgery. LC or OC for 508 AC patients were analyzed using PRFSS, success rate of LC rised significantly from 91.79% to 96.67%, turning to laparotomy rate went down from 4.82% to 1.67%, mean hospital went down to 2.73 days（37.14%）, P 〈0.05, which had significant difference. [Conclusion] PRFSS has great privilege for AC underwent LC, it gets clinical data conveniently, easy to applicate, and it can decrease surgical complication and the rate of turning to laparatomy.