腹腔镜胆囊切除术转开腹的相关因素1:3配对病例对照研究

Study on risk factors for conversion from laparoscopic cholecystectomy to open cholecystectomy with logistic regression analysis

目的探讨腹腔镜胆囊切除术转开腹的相关危险因素。方法采用病例对照组研究对70例腹腔镜胆囊切除术转开腹和210例腹腔镜胆囊切除术成功的患者的临床资料进行对比研究。结果单因素分析显示年龄≥60岁,急性胆囊炎,胆囊壁较厚,胆总管直径增宽,总胆红素升高,开腹组比率明显高于对照组,差异有显著的统计学意义(P<0.01),男性比率开腹组高于成功组,差异有统计学意义(P<0.05)。多因素非条件Logistic回归分析显示:年龄≥60岁、男性、急性胆囊炎、胆囊壁较厚(≥4 mm)、胆总管直径增宽(≥8 mm)、总胆红素升高(>17.1 mol/L)是腹腔镜胆囊切除术转开腹的危险因素。结论有转开腹危险因素的患者应尽量避免进行腹腔镜胆囊切除术或者由腹腔镜手术丰富的临床医师进行腹腔镜胆囊切除术。

Objective To explore the risk factors of conversion from laparoscopic cholecystectomy to open cholecystectomy. Methods The clinical data of 45 patients underwent laparoscopic choleeystectomy during 2009 to 2011 were analyzed for risk factors and conversion rate. Re- suits Multivariate analysis showed that their risk factors were as follows ： thickness of gallbladder wall, number of attacks of cholecystitis, tension of left upper abdominal muscle, the duration from onset of cholecystitis to operation, high serum level of total bilirubin, definition of cystohepatic triangle and Murphy sign. Conclusion Preoperative comprehensive evaluation of risk factors is important for choosing operative method.