急性结石性胆囊炎早期行腹腔镜胆囊切除术中转开腹的相关因素分析

Analysis of related factors of conversion from laparoscopic cholecystectomy to open cholecystectomy in the early stage of acute calculous cholecystitis

目的:探讨急性结石性胆囊炎早期行腹腔镜胆囊切除术(LC)的中转开腹情况及其相关危险因素。方法:选取2017年1月至2019年6月收治的314例急性结石性胆囊炎患者,调查早期行LC的中转开腹率,采用单因素与多因素分析中转开腹的高危因素。结果:29例患者中转开腹,中转率9.24%,主要因胆囊三角解剖关系辨别不明。单因素分析结果显示,中转开腹与发作次数、胆囊壁厚度、发热、急性胆囊炎分级、急性胆囊炎分型、上腹部手术史、术者经验等有关(P<0.05),而与年龄、性别、合并糖尿病、合并高血压、BMI、白细胞计数、结石颈部嵌顿、胆囊肿大、胆囊结石分型、肝功能异常、发病至手术时间、腹腔镜操作方法无关(P>0.05)。Logistic多因素分析显示,胆囊壁≥5 mm、中重度急性胆囊炎、急性坏疽性胆囊炎、胆囊穿孔是急性结石性胆囊炎行LC中转开腹的独立危险因素(P<0.05)。结论:急性胆囊炎早期行LC中转开腹率较高,尤其胆囊壁≥5 mm、中重度急性胆囊炎、急性坏疽性胆囊炎、胆囊穿孔的患者。

Objective:To investigate the incidence and risk factors of conversion from laparoscopic cholecystectomy(LC)to laparotomy in the early stage of acute calculous cholecystitis.Methods:From Jan.2017 to Jun.2019,314 patients with acute calculous cholecystitis were selected to investigate the conversion rate of LC to laparotomy in early stage.The risk factors of conversion to laparotomy were analyzed by univariate and multivariate analysis.Results:Twenty-nine patients were converted to open surgery,the incidence was 9.24%.The main reason was that the anatomical relationship of gallbladder triangle was not clear.Univariate analysis showed that conversion to laparotomy was associated with previous episodes,gallbladder wall thickness,fever,acute cholecystitis classification,acute cholecystitis type,previous epigastric surgery history and surgeon’s experience(P<0.05).However,it was not related to age,sex,diabetes mellitus,hypertension,body mass index,white blood cell count,gallbladder neck incarceration,gallbladder enlargement,types of gallstones,abnormal liver function,time from onset to operation and laparoscopic operation(P>0.05).Logistic multivariate analysis showed that gallbladder wall≥5 mm,moderate to severe acute cholecystitis,acute gangrenous cholecystitis and gallbladder perforation were independent risk factors of conversion to laparotomy in LC for acute calculous cholecystitis(P<0.05).Conclusions:The conversion rate from LC to laparotomy in the early stage of acute calculous cholecystitis is relatively high,especially in patients with gallbladder wall≥5 mm,moderate to severe acute cholecystitis,acute gangrenous cholecystitis and gallbladder perforation.