腹腔镜胆囊切除术中转开腹相关因素的分析

Analysis of related factor about conversion from laparoscopic cholecystectomy to laparotomy

目的:探讨腹腔镜胆囊切除术中转开腹的相关因素。方法:随机选择2004年2月至2010年12月640例腹腔镜胆囊切除术患者作为研究对象,将腹腔镜胆囊切除术中转开腹患者作为观察组,将未中转开腹的患者作为对照组,对可能的影响因素先行单因素分析,再行logistic回归分析。结果:腹腔镜胆囊切除术中转开腹40例;单因素分析12个变量是影响腹腔镜胆囊切除术中转开腹的因素(P<0.05);logistic回归分析结果显示上腹部手术史、年龄、急性炎症、术者技术水平、合并糖尿病是腹腔镜胆囊切除术中转开腹的独立危险因素,其OR值分别为3.42、3.23、2.94、2.74、2.48。结论:腹腔镜胆囊切除术中转开腹的发生与多种因素有关,有上腹部手术史的患者应严格掌握适应证;老年患者遵循个体化原则确定能否施行腹腔镜胆囊切除术;急性炎症发作超过72 h的患者,应先保守治疗;提高术者技术水平,加强糖尿病患者的围手术期处理,可减少中转开腹的发生。

Objective：To investigate the related factor of laparoscopic cholecystectomy （LC） conversion to open surgery. Methods：From Feb. 2004 to Dec. 2010,640 patients accepted LC were randomly selected as study objects,the patients with conversion to open surgery were chosen as observation group, the patients without conversion to open surgery were selected as control group, single factor analysis and logistic regression analysis were respectively carried out on the possible influence factors. Results： Forty cases of LC were converted to open surgery. Single factor analysis revealed that 12 variables were factors affecting LC conversion to open surgery（P 〈 O. 05 ） ; the results of logistic regression analysis showed that upper abdominal surgery histol7, older age, acute inflammation, the tech- nique of surgeon,and combined diabetes disease were independent risk factors for LC conversion to open surgery, and the OR values were 3.42,3.23,2.94,2.74 and 2.48 respectively. Conclusions：The incidence of LC conversion to open surgery is related with many factors, the indication should be strictly controlled for patients with upper abdominal surgery history, old patients should abide by individual principle to determine the implementation of LC ; patients with acute inflammatory attacks more than 72 h should accept conservative treatment firstly ; the level of the surgeon should be improved ; and the perioperative management of diabetes should be strengthened to reduce LC conversion to open surgery.