急性胆囊炎早期腹腔镜治疗术后并发症的高危因素分析

Risk factors analysis on postoperative complications after early laparoscopic cholecystectomy for acute cholecystitis

目的:探讨急性胆囊炎早期行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)术后并发症的相关因素。方法:回顾分析2009年1月至2013年12月737例早期行LC的急性胆囊炎患者的临床资料,应用Logistic多因素回归分析术后并发症的相关危险因素。结果:LC术后15例(2.04%)早期出现并发症,6例再次手术治疗,9例保守治疗,均治愈。单因素分析显示早期LC术后并发症的发生与既往病程、是否为结石性胆囊炎、胆囊三角解剖变异、术者经验及出血量有关(P<0.05),与性别、年龄、肥胖、合并内科疾病、胆囊颈结石嵌顿、胆囊萎缩及放置腹腔引流管无关(P>0.05)。多因素分析显示既往病程、术者经验是早期LC术后并发症的独立危险因素(P<0.05)。结论:急性胆囊炎患者LC术后早期容易发生并发症与既往病程较长、术者经验少相关,术者应加强训练,严格把握手术适应证及中转开腹指征。

Objective： To explore the risk factors of postoperative complications after early laparoscopic cholecystectomy（ LC）in patients with acute cholecystitis. Methods： The clinical data of 737 patients who suffered from acute cholecystitis and underwent early LC from Jan. 2009 to Dec. 2013 were retrospectively analyzed. The related risk factors of postoperative complications were analyzed by multivariate Logistic regression analysis. Results： Postoperative complications occurred in 15 cases after early LC,and the incidence rate was 2. 04%. Among them,6 cases underwent reoperation and the other 9 cases received conservative treatment,all were cured. Univariate analysis identified the following risk factors： course of disease,calculous cholecystitis,anatomic variation of Calot triangle,experience of operators and blood loss（ P 0. 05）. But age,gender,obesity,medical disease,stone incarceration in neck of gallbladder,gallbladder atrophy and abdominal drainage did not have a significant effect on the occurrence of postoperative complications（ P 0. 05）. Logistic regression analysis revealed that course of disease and experience of operators were independent risk factors for postoperative complications（ P 0. 05）. Conclusions： Patients who underwent early LC with long course of disease and less experience of operators tend to suffer from postoperative complications. Proficient operation and sufficient supervision of operative and conversion indications should be offered to them.