探讨腹腔镜胃肠手术中转开腹的影响因素

Exploration on influencing factors of conversion to laparotomy in laparoscopic gastrointestinal surgery

目的研究探讨腹腔镜胃肠手术中转开腹的影响因素。方法 275例实施腹腔镜胃肠择期手术的患者,按照患者是否发生中转开腹分为腹腔镜组与中转开腹组,探讨影响中转开腹的因素。结果 275例实施腹腔镜胃肠择期手术的患者中,24例患者因复杂因素造成术中转行开腹手术根治处理(中转开腹组),余下251例顺利实施手术(腹腔镜组)。两组患者年龄、性别、肿瘤部位比较差异无统计学意义(P>0.05),两组肿瘤分期、肿瘤分化类型及病变程度、术中出血程度与病灶组织粘连情况比较差异具有统计学意义(P<0.05)。Logistic多元回归分析显示,术中出血程度、病灶组织粘连情况、肿瘤分期及肿瘤分化类型及病变程度为腹腔镜胃肠择期手术中转开腹的影响因素(P<0.05)。结论腹腔镜胃肠手术中转开腹影响因素复杂,在临床手术中需严格控制操作流程,明确适应证,结合患者自身手术风险及实际病情变化合适处理,将中转开腹发生率降至最低。

Objective To study and explore influencing factors of conversion to laparotomy in laparoseopic gastrointestinal surgery. Methods A total of 275 patients with laparoscopic gastrointestinal undergoing selective surgery, were divided by whether had conversion to laparotomy into laparoscopic group and conversion to laparotomy group. Factors infected conversion to laparotomy were investigated. Results Among 275 patients with laparoscopie gastrointestinal undergoing selective surgery, 24 patients conversed to laparotomy for radical cure processing due to complicated factors （conversion to laparotomy group）, the other 251 patients received surgery successfully （laparoscopic group）. There were no statistically significant difference in age, sex and tumor location between two groups （P〉0.05）. There were statistically significant difference in neoplasm staging, differentiation type of tumor and pathological change degree, intraoperative bleeding degree and tissue adhesion of lesions between two groups （P〈0.05）. Logistic multivariate regression analysis showed that intraoperative bleeding, intraoperative adhesion degree, neoplasm staging, differentiation type of tumor and pathological change degree were influencing factors of conversion to laparotomy（P〈0.05）. Conclusion Influencing factors of conversion to laparotomy are complicated. Strict operation procedure in clinical surgery, clear indications, and appropriate treatment based on surgical risk and change of illness should be performed to reduce incidence of conversion to laparotomy to a minimum.