预测性评分系统在降低腹腔镜胆囊切除术中转开腹率中应用探讨  

The role of systemic inflammatory response and local anatomy in reducing the probability of conversion in the management laparoscopic cholecystectomy

作　　者：彭永辉 李达强 谢志华 崔文博 龚独辉 莫宇轩 李炳根 聂向阳 PEN Yonghui;LI Daqiang;XIE Zhihua;CUI Wenbo;GONG Duhui;MO Yuxuan;LI Binggen;NIE Xiangyang(Department of Hepatobiliary Surgery,He Xian Memorial Hospital Affiliated to Southern Medical University,Guangzhou,Guangdong 511400,China.)

机构地区：[1]南方医科大学附属何贤纪念医院肝胆外科

出　　处：《岭南现代临床外科》2019年第4期400-404,共5页Lingnan Modern Clinics in Surgery

摘　　要：目的探讨以全身炎症反应及影像学作评分系统在降低腹腔镜胆囊切除术中转开腹率的可行性。方法回顾性分析我院2009年2月~2015年2月所收治发病时间≤72 h的急性结石性胆囊炎行手术治疗892例患者的临床资料,并以前后3年分成A、B两组,以全身炎症反应及影像学作系统评分,探讨预测性评分系统在腹腔镜胆囊切除术中对中转开腹率的影响。结果892例患者均接受手术治疗,未出现术中、术后死亡病例。A、B两组患者在年龄、性别及体重指数上的组间差异均无统计学意义(P>0.05)。在892例患者中,体温≥38.5℃、腹膜炎体征、白细胞计数≥18.0×10^9/L、C-反应蛋白≥30.0 mg/L、胆囊壁厚度≥0.8 cm的组别有着更高的中转开腹率,组间差异均有显著的统计学意义(P<0.001)。以全身炎症反应及影像学作系统评分作术前评估,并以前后3年中转开腹率作对比,有显著差异(P<0.05)。结论以全身炎症反应及影像学作系统评分作术前评估能有效降低中转开腹率。Objective To investigate the role of the systemic inflammatory response and local anatomyin reducing the conversion rate during the approach of laparoscopic cholecystectomy.Methods A totalof 892 patients admitted to our hospital between February 2005 and February 2015 were analyzedretrospectively.All their cholecystitis onset were smaller than 72 hours and all of them underwent surgery.The patients were divided into two group according to the time when the approach of laparoscopic cholecys.tectomy,and the role of the systemic inflammatory response and local anatomical factors affecting theconversion of laparoscopic cholecystectomy were discussed.Results All 892 patients underwent surgerywithout any intraoperative or postoperative deaths.There were no significant differences in age,gender andbody mass index between groups A and B(P>0.05).The difference of probability of conversion wassignificantly in the aspect of factors including fever(≥38.5℃),peritonitis,white blood cell(WBC≥18.0×10^9/L),C-reactive protein(CRP≥30.0 mg/L)and gallbladder wall thickness(≥0.8 cm)(P<0.05).Conclusion The assessment of fever,peritonitis,WBC,CRP and the local anatomical of gallbladdercan effectively reduce the rate of conversion.

关 键 词：腹腔镜胆囊切除术 中转开腹 预测 评分系统 

分 类 号：R657.4[医药卫生—外科学]