腹腔镜胆囊切除术难易度相关因素分析及其评分标准的初探  

Analysis of factors related to difficulty level of laparoscopic cholecystectomy and preliminary study of its scoring criteria

作　　者：张辉[1] 李军[1] 

机构地区：[1]上海市长宁区中心医院普通外科,上海200336

出　　处：《中国普通外科杂志》2011年第8期793-796,共4页China Journal of General Surgery

摘　　要：目的建立腹腔镜(LC)难易程度的评分标准。方法对5年间实施LC的845例患者术前、术中临床资料进行单因素分析,筛选引起手术困难的危险因素后进行Logistic多元回归分析,并对诸因素进行赋值,建立LC难易程度的评分标准。结果胆囊壁增厚(≥4mm),胆总管直径(CBD≥8mm),胆囊体积(≥103cm3或<6.3cm3),胆囊本身炎症状况,胆囊三角致密粘连等因素是导致手术困难乃至中转开腹(OC)的危险因素。根据上述因素建立LC难易程度评分标准。结论 LC难易度评分标准的建立有利于临床选择LC或中转OC。Objective To establish a scoring criteria for assessment of the difficulty levels of laparoscopic cholecystectomy（LC）. Methods The preoperative and intraopertive clinical data of 845 LC patients treated during a period of five years were analyzed.The data were firstly analyzed with univariate methods to screen out the risk factors causing the operative difficulties,which were further identified by multivariate Logistic regression analysis.Numerical values were assigned to these factors to construct the scoring criteria predicting the difficulty levels of LC. Results The risk factors causing operative difficulties or even converting to open cholecystectomy（OC） were identified,which included the thickness of gallbladder wall（≥4 mm）,diameter of the common bile duct（≥8 mm）,size of gallbladder（≥103 cm3 and 6.3 cm3）,cholecystic inflammation and severe adhesions in the Calot′s triangle.The scoring criteria for assessing difficulty levels of LC were obtained based on these factors. Conclusions The establishment of scoring criteria is clinically helpful for the selection of LC or OC convertion.

关 键 词：胆囊切除术 腹腔镜 难易程度 评分标准 LOGISTIC模型 

分 类 号：R657.4[医药卫生—外科学]