腹腔镜胆囊切除术中转开腹115例相关风险因素的分析

Related risk factors analysis of conversion to laparotomy in 115 cases of laparoscopic cholecystectomy for acute cholecystitis

目的探讨行腹腔镜胆囊切除术（LC）的急性胆囊炎患者中转开腹的相关危险因素。方法选取行LC手术的急性胆囊炎患者2 350例，其中中转开腹患者115例为实验组，同时随机选取115例顺利进行LC手术的患者为对照组。比较两组患者的临床资料，采用单因素分析发生中转开腹的危险因素，采用多因素分析发生中转开腹的独立危险因素。结果115例中转开腹患者中男54例（46.96%），女61例（53.04%），男性与女性比例比较差异未见统计学意义（P〉0.05）；白蛋白降低、纤维蛋白原升高、术中出血量〉100 ml、胆囊壁厚增加、胆囊坏疽与糖尿病发生率提高等因素增加了LC手术患者中转开腹的风险（P均〈0.05）。多因素Logistic回归分析显示，术中出血量（OR＝1.989，95%CI：1.978～1.999，P＝0.022）与白蛋白（OR＝1.259，95%CI：1.038～1.526，P＝0.021）是LC手术患者中转开腹的独立危险因素。结论纤维蛋白原、胆囊坏疽、术中出血量、白蛋白、胆囊壁增厚是LC患者行腹腔镜手术中转开腹的危险因素，术中出血量与白蛋白是中转开腹发生的独立危险因素。

ObjectiveTo investigate the related risk factors of conversion to laparotomy in laparoscopic cholecystectomy（LC） for acute cholecystitis.MethodsTwo thousand three hundred and fifty LC patients with acute cholecystitis were selected, among them, 115 cases converted to laparotomy were selected as the experiment group, at the same time, 115 patients with LC surgery were randomly selected as the control group. The clinical data of the two groups were compared. Single factor analysis was used to analyze the risk factors of conversion to open surgery, and independent risk factors for conversion to open surgery were analyzed by multivariate analysis.ResultsThe proportion of male in 115 patients was 48.2%, female was 51.7%, there was no significant difference in the proportion of male and female （P〉0.05）. The factors including decreased albumin, increased fibrinogen, blood loss greater than 100 ml, increased gallbladder wall thickness, gangrene of gallbladder, increased incidence of diabetic increased the risk of conversion to open surgery in patients with LC（P all〈0.05）. Multivariate logistic regression analysis showed that blood loss （OR=1.989, 95%CI： 1.978-1.999, P=0.022） and albumin （OR=1.259, 95%CI： 1.038-1.526, P=0.021） were the LC independent risk factors for conversion to laparotomy in patients underwent LC.ConclusionsFibrinogen, gallbladder gangrene, blood loss, albumin, gallbladder wall thickening are risk factors of LC patients underwent laparoscopic surgery laparotomy. The blood loss and albumin are independent risk factors for laparotomy.