腹腔镜胆囊切除术中转开腹的影响因素分析

Analysis of influencing factors for conversion of laparoscopic cholecystectomy to open surgery

目的探讨腹腔镜胆囊切除术（LC）中转开腹的影响因素,为临床制订手术方案提供参考。方法选取2009年1月-2013年12月于佛冈县人民医院进行LC治疗的278例患者,其中中转开腹31例（称为中转组）,其余247例为非中转组。分析中转开腹的相关因素。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验,将单因素分析后存在统计学意义的指标进行多因素Logistic回归分析,得出相关性,评判出有价值的影响因素。结果单因素分析结果显示,性别（P=0.022）、动脉硬化（P〈0.001）、糖尿病（P〈0.001）、心力衰竭（P=0.002）、上腹部手术史（P〈0.001）、年龄（P〈0.001）、BMI（P=0.003）、胆囊壁厚度（P〈0.001）、白细胞计数（P〈0.001）和血清TBil（P=0.046）在两组间差异具有统计学意义。进一步行多因素Logistic回归分析表明,上腹部手术史（P〈0.001）、性别（P=0.001）、BMI（P=0.002）和白细胞计数（P=0.019）是中转开腹的独立影响因素,其中上腹部手术史（OR=4.646,95%可信区间：2.012-10.729）为影响强度最大的因素。结论上腹部手术史、性别、BMI、白细胞计数为腹腔镜胆囊切除手术中转开腹的独立影响因素,对此类高危指标进行术前评估有利于在行开腹手术时提高手术效率,具有重要临床价值。

Objective To analyze the influencing factors for conversion of laparoscopic cholecystectomy to open surgery,and to provide a clinical reference for developing surgical procedures. Methods A total of 278 patients receiving laparoscopic cholecystectomy in our hospital from January 2009 to December 2013 were analyzed. Among them,31 patients were converted to open surgery during laparoscopic cholecystectomy,while the remaining 274 patients were not. The influencing factors for conversion to open surgery were investigated. The t test was applied in the comparison of continuous data,whereas the χ2test was used for categorical data. The univariate logistic regression analysis was performed to investigate significant influencing factors,and the independent influencing factors were determined by multivariate logistic regression analysis. Results The univariate analysis showed that sex（ P = 0. 022）,arteriosclerosis（ P〈0. 001）,diabetes（ P〈0. 001）,heart failure（ P = 0. 002）,previous upper abdominal surgery（ P〈0. 001）,age（ P〈0. 001）,body mass index（ BMI）（ P = 0. 003）,gallbladder wall thickness（ P〈0. 001）,the count of white blood cells（ P〈0. 001）,and serum total bilirubin level（ P = 0. 046） were significantly different between groups. The multivariate logistic regression analysis further showed that previous upper abdominal surgery（ P〈0. 001）,sex（ P = 0. 001）,BMI（ P = 0. 002）,and the count of white blood cells（ P = 0. 019） were independent influencing factors,among which previous upper abdominal surgery was the most significant one（ OR = 4. 646,95% CI： 2. 012- 10. 729）. Conclusion Previous upper abdominal surgery,sex,BMI,and the count of white blood cells were independent influencing factors for conversion of laparoscopic cholecystectomy to open surgery. Careful evaluation of these factors before surgery would help to increase the operation efficacy,possessing an important clinical value.