腹腔镜胆囊切除中转开腹的危险因素分析

摘要

Objective To analyze the risk factors of laparoscopic cholecystectomy converted to open management. Methods Collecting the patients undergoing cholecystectomy in our center,according to conversion to open management or not, we divided the patients in laparoscopic cholecystectomy( LC )group and laparoscopic to open cholecystectomy( LOC ) group. The single factor analysis would be performed with age, gender, diabetes, cardiovascular disease, arteriosclerosis, previous upper abdominal surgery, body mass index( BMI), gallbladder wall thickness, count of white blood cells, drinking, gallbladder enlargement and impacted stones and serum total bilirubin, then we enrolled those with statistical difference in the binary logistic regression model, and evaluated which was the independent risk factor. Results A total of 260 patients were enrolled. There were statistical differences in age, gender, diabetes, arteriosclerosis, previous upper abdominal surgery, BMI, gallbladder wall thickness, count of white blood cells and serum total bilirubin. After the logistic regression, we found that gender, BMI,gallbladder wall thickness and count of white blood cells could be treated as the independent risk factor. The operation time of LOC was higher than LC[ ( 83.48 ±7.25 )min vs( 42.77 ± 10.37 )min,t = 19. 54,P <0.01 ]. Conclusion LC is a safe and effective management for gallbladder disease but it is technically demanding. Patients with elder age,gender as man,obesity, gallbladder wall thickening and high WBC count prefer to have open cholecystectomy directly.%目的 分析影响腹腔镜胆囊切除中转开腹的相关因素,以进一步指导临床.方法 选取该院近5年行胆囊切除的患者,对其相关指标进行单因素及Logistic回归分析,从而找出相关危险因素或独立危险因素.结果 共260例患者纳入本次研究,经单因素分析显示中转组和非中转组年龄、性别、糖尿病、动脉硬化、上腹部手术史、BMI、胆囊壁厚度、白细胞计数、血清总胆红素及心衰差异有统计学意义,进一步对上述因素进行Logistic逐步回归分析发现性别、BMI、胆囊壁厚度和白细胞计数是独立危险因素,其余所纳入模型的因素对是否中转开腹亦有影响.对两组患者的手术时间进行比较发现中转组明显长于非中转组[(83.48±7.25)min vs(42.77±10.37)min,t=19.54,P<0.01].结论 性别、BMI、胆囊壁厚度和白细胞计数是影响腹腔镜胆囊切除中转开腹的独立危险因素,术前对相关指标的评估对高危患者直接行开腹手术有利于提高手术效率.