腹腔镜胆囊切除术转开腹可能性评分系统建立和运用  

Establishment and application of scoring system predicting probability of conversion of laparoscopic cholecystectomy to open cholecystectomy

作　　者：蔡秀军[1] 周振旭[1] 陈继达[1] 王先法[1] 虞洪[1] 郑雪咏[1] 梁霄[1] 李其肯[1] 

机构地区：[1]浙江大学医学院附属邵逸夫医院普外科,杭州市310016

出　　处：《中华肝胆外科杂志》2004年第2期97-102,共6页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的　根据术前临床资料建立预测腹腔镜胆囊切除术转开腹可能性的评分系统。方法　对邵逸夫医院 1994年 4月 4日至 2 0 0 1年 6月 30日的 7134例LC的术前临床资料进行单因素分析 ,筛选出中转开腹的危险因素 ,再进行logistic多元回归分析。男性、高龄 (≥ 6 5岁 )、上腹部手术史、糖尿病、总胆红素升高 (≥ 1 2mg/dl)、胆囊壁增厚 (≥ 4cm )、胆总管直径增宽 (≥ 8cm)、急性胆囊炎是转开腹的危险因素并被分别赋值 ,建立预测转开腹可能性的评分系统。计算 7134例LC的综合得分 ,比较不同得分组转开腹率。用ROC曲线评价该评分系统的效能。 2 0 0 1年 7月 1日至 2 0 0 1年 12月 31日 938例LC运用该评分系统 ,比较各得分组转开腹率的差异。结果　 7134例LC中各组得分越高 ,转开腹率越高 ,且多数相邻两组的转开腹率有显著性差异 (P <0 0 1)。ROC曲线以下面积为0 81,标准误为 0 0 1。 938例LC中的各组也是得分越高 ,转开腹率越高 ,且多数相邻两组的转开腹率有显著性差异 (P <0 0 5 )。结论　根据危险因素预测LC转开腹可能性 ,以指导临床工作。Objective To establish a scoring system that predicts the probability of conversion of laparoscopic cholecystectomy (LC) to open cholecystectomy (OC) based on preoperative clinical data. Methods Anivariable analysis was performed for the preoperative clinical data of the 7134 receiving LC in our hospital from 4/4/1994 to 6/30/2001. Then multivariable analysis with logistic regression was performed for the selected risk factors. Male, ≥65 years old, history of upper abdominal operation, diabetes, high level of total bilirubin (≥1.2 mg/dl), thickened wall of gallbladder (≥4 cm), dilated diameter of the common bile duct (≥8 cm) and acute cholecystitis were risk factors and given scores, respectively. Thus the scoring system was established. The comprehensive scores were calculated for all the 7 134 cases. The conversion rates of different score groups were compared. The scoring system was evaluated with ROC curve. Furthermore, the scoring system was used for 983 cases receiving LC in our hospital from 7/1/2001 to 12/31/2001. The conversion rates were compared among groups with different scores. Results For the 7 134 cases, the higher score a group had, the higher conversion rate it had. The conversion rates of most adjoining groups had significantly statistical difference (P <0.01). The area below ROC curve was 0.81 and its stand error was 0.01. For the 983 cases, the conversion rates of most adjoining groups had statistical difference ( P <0.05). Conclusions The probability of conversion of LC to OC can be predicted based on risk factors to guide clinical practice.

关 键 词：开腹 LC 评分系统 腹腔镜胆囊切除术 危险因素 ROC曲线 术前 标准误 筛选 

分 类 号：R657.4[医药卫生—外科学] R656[医药卫生—临床医学]