急性胆囊炎行腹腔镜胆囊切除术中转开腹的危险因素分析

Risk factors for conversion of laparoscopic cholecystectomy to open cholecystectomy in patients with acute cholecystitis

目的探讨急性胆囊炎性腹腔镜胆囊切除术中转开腹的危险因素。方法回顾分析507例急性胆囊炎患者的临床资料,采用单因素分析及多因素Logistic回归分析,探讨影响中转开腹的危险因素。结果 194例患者中,29例中转开腹,中转率为14.9%;微创组与中转开腹组在手术时间、术中出血量、术后通气时间及术后住院时间方面差异有统计学意义(P<0.05);单因素分析结果提示:炎症发作时间、既往腹部手术史、炎症发作次数、胆囊壁厚度、术者手术经验及白细胞计数与腹腔镜胆囊切除术中转开腹相关(P<0.05);多因素分析结果提示:既往腹部手术史、胆囊壁的厚度、炎症发作次数及术者手术经验是影响微创胆囊切除手术中转开腹的独立危险因素(P<0.05)。结论术前正确评估腹腔镜胆囊切除术中转开腹的相关危险因素,可为外科医生术中决策提供一定的参考,并可减少手术并发症。

Objective To investigate the risk factors of intraoperative conversion from laparoscopic cholecystectomy to open cholecystec-tomy in patients with acute cholecystitis.Methods A retrospective analysis of clinical data of 194 patients with acute cholecystitis was performed.Risk factors were evaluated by univariate analysis and Logistic multiple regression analysis.Results Of the 194 patients,29 were converted to open cholecystectomy,with an overall conversion rate of 14.9%.The operative time,blood loss,exsufflation time and postoperative hospital stay were significantly different between conversion and laparoscopy group（P 〈0.05）.Univariate analysis indica-ted that cholecystitis seizure time,abdominal surgery history,seizure frequency of acute cholecystitis,gallbladder wall thickness,experi-ence of operator and white blood cell count were closely associated with intraoperative conversion（P 〈0.05 ）.Multivariate analysis showed that abdominal surgery history,gallbladder wall thickness,seizure frequency of acute cholecystitis and experience of operator were independent risk factors of laparoscopic cholecystectomy converted to open surgery（P 〈0.05）.Conclusions Correct assessment of risk factors for conversion of laparoscopic cholecystectomy to open cholecystectomy can provide a reference for surgeons,and reduce complications.