基于东京指南(2018)下中度(Ⅱ级)急性胆囊炎行腹腔镜胆囊切除中转开腹危险因素分析  

Risk factors of conversion from laparoscopic cholecystectomy to open cholecystectomy for moderate(levelⅡ)acute cholecystitis based on Tokyo guidelines(2018)

作　　者：刘林勋[1] 杨金煜[1] 叶成杰[1] 徐正光[1] 马连 Liu Linxun;Yang Jingyu;Ye Chengjie;Xu Zhengguang;Ma Lian(Department of General Surgery,Qinghai provice People’s Hospital,Xining,QingHai,810007 China)

机构地区：[1]青海省人民医院普通外科,青海西宁810007

出　　处：《中华普外科手术学杂志（电子版）》2020年第5期512-516,共5页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：青海省基础研究计划项目(2018-ZJ-758)。

摘　　要：目的探讨中度(Ⅱ级)急性胆囊炎行腹腔镜胆囊切除(LC)中转开腹的危险因素。方法回顾性分析2014年1月至2016年1月137例急性胆囊炎患者资料,57例患者行LC,80例患者行LC中转开腹,依据手术方式不同分成LC组和中转开腹组。所有数据采用SPSS13.0统计软件进行处理。计量资料以(±s)表示,对各变量进行正态性检验,各变量未通过正态性检验(P<0.05),以连续性变量以中位数(四分位间距)表示并做秩和检验。多因素分析采用Logistic回归分析,P<0.05为差异有统计学意义。结果(1)单因素分析结果显示:患者年龄、急性胆囊炎发生次数、患者本次发病最高白细胞计数、患者最高体温、彩超诊断下胆囊厚度、胆囊大小中转开腹组均显著高于LC组(P<0.05),LC医师年资中转开腹组均显著低于LC组(P<0.05)。(2)多因素分析结果显示:急性胆囊炎发生次数,患者本次发病最高体温是中转开腹的独立危险因素,LC医师年资是中转开腹的独立保护因素。结论急性胆囊炎发生次数、患者体温是中度(Ⅱ级)急性胆囊炎行LC中转开腹独立危险因素,有经验的手术医师可以减少该类疾病中转开腹的概率。Objective To investigate the risk factors of conversion from laparoscopic cholecystectomy(LC)to open cholecystectomy(OC)for moderate(levelⅡ)acute cholecystitis based on Tokyo guidelines(2018).Methods The data of 137 patients with acute cholecystitis from January 2014 to January 2016 were retrospectively analyzed.LC was performed in 57 patients,and conversion from LC to OC was performed in 80 patient,which were divided into LC group and Conversion group.Data were processed by SPSS13.0 statistical software.Measuring data were expressed as(mean±SD)and tested for the normality of variables.Variables did not pass the normality test were expressed as median(quartile spacing)and rank sum test was performed.Logistic regression analysis was used for multivariate analysis,(P<0.05)was statistically significant and the independent risk factors affecting conversion were determined.Results(1)The risk factors of conversion to OC for moderate(levelⅡ)acute cholecystitis were analyzed by single factor analysis.The results showed that age,frequency of seizures,white blood cell count,patient’s highest body temperature,gallbladder thickness and gallbladder size in the Conversion group were significantly higher than those in the LC group(P<0.05).The seniority of surgeon in the Conversion group was significantly lower than that in the LC group(P<0.05).Multivariate analysis showed that the frequency of seizures and the highest body temperature of patients were independent risk factors for conversion to OC,and the seniority of surgeon was an independent protective factor for conversion to OC.Conclusion The frequency of seizures and the highest body temperature of patients are independent risk factors for conversion to OC for moderate(levelⅡ)acute cholecystitis.Experienced surgeons can reduce the probability of conversion to OC in such diseases.

关 键 词：胆囊炎 急性 胆囊切除术 腹腔镜 剖腹术 危险因素 东京指南(2018) 中度(Ⅱ级) 

分 类 号：R657.41[医药卫生—外科学]