腹腔镜胆囊切除中转开腹相关因素病例对照研究

Case control Study of Conversion to Laparotomy in Laparoscopic Cholecystectomy

目的：探讨腹腔镜胆囊切除中转开腹相关因素,提出预防对策。方法：回顾性分析2005年1月-2012年3月腹腔镜胆囊切除术1080例患者的临床资料,将腹腔镜胆囊切除中转开腹者作为观察组,按照1：2比例选择未中转开腹者作为对照组,比较两组可能影响因素上的差异。结果：1080例患者中转开腹42例（2.92%）,单因素检验显示11个变量差异有显著性（P〈0.05）,Logistic回归分析显示中转开腹独立危险因素为：腹部手术史（OR=3.53）、年龄≥60岁（OR=3.32）、急性炎症（OR=3.03）、医生水平不成熟（OR=2.88）。结论：腹腔镜胆囊切除存在一定程度的中转开腹,影响因素复杂,应该实施针对性措施减少中转开腹。

Objective：To explore the related factors of laparoscopic cholecystectomy conversion to laparotomy,preventive measures.Methods：Retrospective analysis of clinical data in January 2005-March 2012 1080 cases laparoscopic cholecystectomy patients,laparoscopic laparotomy were selected as observation group,according to the 1：2 proportional selection without conversion to open surgery as control group,compared two groups of factors that might influence the differences.Results：1080 patients were converted to laparotomy 42 cases （2.92%）,single factor test showed significant difference 11 variables （P〈0.05）,Logistic regression analysis showed that the independent risk factors for conversion to laparotomy：history of abdominal operation （OR=3.53）,60 years of age or older （OR=3.32）,acute inflammation （OR=3.03）,doctors （not mature OR=2.88）.Conclusion：Laparoscopic cholecystectomy has a certain degree of conversion to laparotomy,and complex influence factors,should be the implementation of specific measures to reduce the conversion to laparotomy.