腹腔镜胆囊切除中转剖腹手术的影响因素分析  

The analysis of the influencing factors of conversion of laparoscopic cholecystectomy to open surgery

作　　者：郑泽群 杨士勇[1] 刘子君[1] Zheng Zequn

机构地区：[1]南京医科大学附属南京医院,南京市第一医院,210006

出　　处：《浙江临床医学》2022年第2期182-185,共4页Zhejiang Clinical Medical Journal

摘　　要：目的探讨腹腔镜胆食切除中转剖腹手术的影响因素。方法回顾性分析单纯行胆食切除术的患者4,214例。收集患者的一般信息、病史、实验室检查结果、影像学检查结果、术中情况、中转剖腹手术的原因及手术医师等资料。按照腹腔镜中转剖腹胆囊切除术(LC-OC)组与腹腔镜胆囊切除术(LC)组1:4的比例在LC患者中单纯随机抽样入组进行LC-OC的影响因素分析。对LC例数超过50例的手术医师LC中转率进行统计分析结果。4,214例单纯胆囊切除患者,其中3,998例行LC,102例行LC-OC,LC中转率为2.49%;114例行直接剖腹胆食切除术(OC)。LC中转OC的常见原因为胆囊三角解剖困难(69.61%)。LC-OC组的男性比例、年龄、发病至就诊时间、腹痛急性发作比例、术前WBC计数、影像学检查示胆囊颈部结石嵌顿及胆囊壁厚≥4mm的比例均显著高于LC组,差异有统计学意义(P<0.05)。LC-OC组中术后病理为黄色肉芽肿性胆囊炎、坏疽性胆囊炎的比例也显著高于LC组,差异有统计学意义(P<0.05)。多因素Logistic分析显示,男性、高龄、发病至就诊时间延长、术前白细胞计数升高、胆囊壁增厚≥4 mm、黄色肉芽肿性胆囊炎是LC中转OC的独立危险因素。22位手术医师的LC手术例数超过50例,其中18位手术医师LC中转率与平均水平无统计学差异(P>0.05),2位手术医师LC中转率显著高于平均水平(P<0.05),2位医师LC中转率显著低于平均水平(P<0.05),且与技术职称无关。结论术前实验室检查及影像学检查有助于评估LC手术中转风险,手术医师的技术水平是LC中转剖腹手术的重要影响因素。Objective To explore the influencing factors of conversion of laparoscopic cholecystectomy to open surgery.Methods A retrospective analysis was perfonncd on 4,214 patients undergoing cholecystectomy alone.Collect patients'general infonnation,medical history,laboratory examination results,imaging findings,intraoperative conditions,reasons for conversion to laparotomy and surgical physicians etc.According to the ratio of laparoscopic conversion-open cholecystectomy(LC-OC)group and laparoscopic cholecystectomy(LC)group of 1:4,the LC patients were randomly selected to analyze the influencing factors of LC-OC.The conversion rate of LC among surgeons with more than 50 cases was statistically analyzed.Results Among the 4,214 patients with eholecysteetomy alone,3,998 patients received LG and 102 patients received LC-OC,with a LC conversion rate of 2.49%.Open cholecystectomy(OC)was performed in 114 patients.The common reason for transition to OC in LC was anatomic difficulty in gallbladder triangle(69.61%).The proportion ot males,age,time from onset to visit,proportion of acute onset of abdominal pain,preoperative WBC count,and proportion of gallbladder neck stone incarceration and gallbladder wall thickness≥4 mm in the LC-OC group were significantly higher than those in the LC group,with statistical significance(P<0.05).The proportion of postoperative pathological manifestations of xanthogranulomatous cholecystitis and gangrenous cholecysriris in the LC-OC group was also significantly higher than that in the LC group,with statistical significance(P<0.05).Multivariate Logistic analysis showed that male,old age,prolonged time from onset to treatment,increased preoperative white blood cell count,gallbladder wall thickening≥4 mm,xanthogranulomatous cholecystitis were independent risk factors for conversion from LC to LC.There were 22 surgeons who had done more than 50 LC,of which 18 surgeons the LC conversion rate had no statistical difference with the average level(P>0.05).There were 2 surgeons whose conversion rate wer

关 键 词：腹腔镜中转剖腹胆囊切除术 疾病相关因素 手术医师因素 

分 类 号：R65[医药卫生—外科学]