腹腔镜阑尾切除术中转开腹相关危险因素的分析

Analysis of relative risk factors of laparoscopic appendectomy for conversion to laparotomy

目的:探讨影响腹腔镜阑尾切除术(laparoscopic appendectomy,LA)中转开腹的相关因素。方法:回顾分析2014年4月至2016年5月施行LA的患者中6例急性阑尾炎患者中转开腹的临床资料,分析影响中转开腹的相关危险因素。结果:LA中转开腹率为4.2%。单因素分析表明,发病时间、阑尾致密粘连、根部坏疽或穿孔、盲肠后位阑尾与LA中转开腹有关(P<0.05)。Logistic回归分析表明,阑尾致密粘连(OR=1.258,P<0.05)是LA中转开腹的独立危险因素。结论:阑尾致密粘连是LA中转开腹的独立危险因素。术前应建立合理的评判标准、选择合理的手术时机及手术方式,尽可能避免中转开腹。

Objective：To investigate the related factors of laparoscopic appendectomy （LA） conversion to laparotomy. Meth- ods：From Apr. 2014 to May 2016, LA was performed for 143 patients in Nanjing Tongren Hospital Affiliated to Medical College of Southeast University. 6 patients were converted to laparotomy. The retrospective analysis was made on the relative reasons of LA conver- sion to open appendectomy. Results：The conversion rate was 4.2%. By univariate analysis, conversion was significantly associated with onset time, compact adhesion, appendiccal perforation or gangrene and retrocecal location （ P 〈 0.05 ）. By logistic regression analysis, appendiceal compact adhesion （ OR = 1. 258 ,P 〈 0.05 ） was an independent risk factor. Conclusions ：The factor significantly related to LA converting to laparotomy is appendiceal compact adhesion. It is necessary to avoid conversion by establishing rational preoperative criteria and choosing proper operation timing and method.