腹腔镜胆囊切除术中转开腹因素分析

An analysis of risk factors for conversion of Laparoscopic cholecystectomy to open surgery

目的探讨腹腔镜胆囊切除术(LC)中转开腹的因素。方法回顾性分析我院2002年1月至2007年1月1 685例LC病例的临床资料,选取其中42例中转开腹病例作为本文研究的对象,随机选择同期LC术成功组200例成作为比较对象,并对其进行单因素分析和Logistic多元回归分析。结果男性、高龄(≥60岁)、胆囊萎缩(≤4.5 cm×1.5 cm)、胆囊壁增厚(≥0.4cm)、急性胆囊炎、胆囊颈部结石嵌顿、糖尿病、上腹部手术史以及总胆红素升高(>17.1μmol.L-1)是转开腹的因素。结论术前仔细评估、筛选病例对提高LC术成功率、减少术后并发症具有重要意义。

Aim To investigate the factors about conversion of Laparoscopic cholecystectomy（LC） to open surgery. Methods Anivariable analysis was performed for the preoperative clinical data of the 42 LC cases conversing to OC and 200 LC cases selecting stochasticly in our hospital from 1/2002 to 1/2007. Then muhivariable analysis with logistic regression was performed for the selected risk factors. Results Male≥60 years old,atrophy of gallbladder（ ≤4.5 cm × 1.5 cm）, thickened wall of gallbladder（≥0.4 cm）, high level of total bilirubin（ 〉 17.1 μmol·L^-1 ） ,history of upper abdominal operation, diabetes and acute cholecystitis were risk factors of conversion of LC to OC. Conclusion Evaluating and screening cases carefully is very important to raise achievement ratio an to reduce complication.