腹腔镜胆囊切除术致严重并发症的分布及危险因素分析—单中心71238例临床资料总结

The risk factors of distribution and serious complications induced by laparoscopic cholecystectomy in a single center:an analysis of 71238 cases

目的探讨腹腔镜胆囊切除术(LC)导致严重并发症的分布及相关危险因素。方法回顾性分析1992年10月～2011年07月71238例腹腔镜胆囊切除术并发症的临床资料,采用χ2检验和Logistic回归方法对可能导致LC并发症的16个临床相关因素进行统计学分析。结果 LC术后严重并发症的发生率为0.37%(262/71238),其中因发生并发症而中转开腹173例,占66.1%(173/262)。Logistic回归分析显示:Calot三角粘连、解剖变异、病期、胆囊壁厚度、胆囊萎缩为导致LC并发症发生的主要危险因素。结论加强医师的腹腔镜技术培训,严格掌握LC适应证,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 investigate the risk factors of distribution and serious complications in patients undergoing laparoscopic cholecystectomy（LC）. Methods Clinical data of 71238 patients undergoing LC from October. 1992 to July. 2011 were collected and analyzed retrospectively. Fifteen clinical factors were recruited for the study in relation to serious complications by χ2 test and Logistic regression. Results The overall operative serious complication rate was 0. 37% （262/71238）. The procedure was shifted to open surgery is 66. 1% （173/262） of all the serious complication cases. Stepwise Logistic regression analysis displayed that calot triangle adhesion, anatomic variation, stage, gallbadder wall thickness and gallbladder atrophic were important risk factors for complications. Conclusion LC complications can be prevented by good training, strict indication of laparoscopic resection of the gallbladder ,and timely shifting to open suegery.