摘要
目的 探讨急性胆囊炎腹腔镜胆囊切除术 (LC)技术难度的影响因素。方法 回顾 15 3例急性胆囊炎LC的临床资料 ,并对术前和术中难度指标进行对比分析。结果 影响急性胆囊炎LC技术难度的因素有上腹部手术史或发作史 ,右上腹肌紧张 ,白细胞增高 ,胆囊壁增厚 ,胆囊管结石嵌顿 ,胆囊图像缺失 ,发病超过 72h。术前判断为容易与困难者分别为 2 0 9%及 79 1% ,与术中发现相一致。术前难度计分与手术难度呈正相关 (相关系数r =0 .5 14 ,P <0 .0 1)。结论 急性胆囊炎的术前手术难度计分有助于外科医生对病人LC技术难度进行全面评估 ,以提高LC的成功率 。
Objective To discuss the influential factors on technical difficulties of laparoscopic cholecystectomy (LC) for acute cholecystitis. Methods\ The technical difficulty indexes before and during LC were summarized and analyzed retrospectively in 153 patients with acute cholecystitis. Results \ The influential factors on technical difficulties of LC for acute cholecystitis included previous upper abdominal operation or recurrence history, rigidity in upper right abdomen, leukocytosis, thickened gallbladder wall, stone incarceration on the neck of the gallbladder, no visualization of the gallbladder sonarographically and more than 72 hours of onset of symptomatic cholelithiasis. The operation was predicted to be easy in 20.9% and difficult in 79.1% of cases, in correspondence with the surgeon′s intraoperative judgment. There was a positive relationship between technical difficulties score before LC and operative difficulties during LC ( r= 0.514, P <0.01) . Conclusions\ The technical difficulties score before LC in acute cholecystitis was helpful for evaluating the operative difficulties, increasing the operative successful rate, and decreasing the conversion rate and complication incidence of LC.
