急性胆囊炎腹腔镜胆囊切除术中转手术的相关因素评估

RELATED FACTORS FOR CONVERSION TO OPEN SURGERY IN PATENTS WITH ACUTE CHOLECYSTITIS UNDERGOING INTERVAL LAPAROSCOPIC CHOLECYSTECTOMY

目的探讨急性胆囊炎腹腔镜胆囊切除术中转手术的相关因素。方法回顾性分析我院2005年1月～2010年11月间,332例急性胆囊炎患者行腹腔镜胆囊切除术的病例资料;其中,中转手术51例。通过比较腹腔镜手术组和中转手术组患者的年龄,性别,体重指数,术前全血白细胞计数、碱性磷酸酶、总胆红素、血清谷丙转氨酶水平、谷草转氨酶、合并糖尿病,发病时间,手术时间,住院时间和术后并发症之间的差异;分析与中转手术相关的因素。统计学分析采用t检验和PearsonChi-Square检验。结果中转手术患者的年龄,体重指数,术前全血白细胞计数、碱性磷酸酶、总胆红素、发病时间高于腹腔镜手术组,两组间差异有显著的统计学意义(P<0.05);而性别,术前血清谷丙转氨酶水平、谷草转氨酶、合并糖尿病在两组间的差异无统计学意义(P>0.05)。中转手术组手术时间、住院时间及术后并发症高于腹腔镜手术组(P=0.00)。结论腹腔镜胆囊切除术是治疗急性胆囊炎的安全术式;高龄,肥胖,术前全血白细胞、总胆红素、发病时间和碱性磷酸酶增高是中转手术的高危因素;中转手术患者的手术时间和住院时间延长,术后并发症发生率增高。

Objective To explore the related factors for comversion to open surgery in patients with acute cholecystitis undergoing laparoscopic cholecystectomy.Methods To retrospectively reveriew and analyze 332 patients with acute cholecystitis undergoing laparoscopic cholecystectomy from January 2005 to November 2010.Among them,51 patients had convert to open cholecystectomy and were put into conversion group,and the others were into LC group.Patient＇s age,sex,BMI,total white cell count,alkaline phosphatase,total bilirubin,serum alanine aminotransferase,aspartate aminotransferase,diabetes mellitus,disease onset time,operative times,length of stay and postoperative complications were analyzed and compared between two groups.Statistical analysis was done using t test and repeated measures test.Results Patient＇s age,BMI,total white cell count,alkaline phosphatase,total bilirubin,disease onset time,operative times,length of stay and postoperative complications were found to be independently associated with conversion group（P0.05）.But there was no statistical difference in other factors in two groups.Conclusions Laparoscopic cholecystectomy can be performed safely for acute cholecystitis.Age,obesity,totle white cell count,alkaline phosphatase,total bilirubin are risk factors for conversion.Operative time and length of stay are longer and higher postoperative complications in Conversion group than LC group.