回溯手术评估安全性关键术野技术在LC中的应用价值  

Application value of retrospective operation evaluation of critical view of safety technology in laparoscopic cholecystectomy

作　　者：胡金龙 李敏 刘东全 袁中旭 姚佳明 钟兴国 曹葆强 HU Jinlong;LI Min;LIU Dongquan;YUAN Zhongxu;YAO Jiaming;ZHONG Xingguo;CAO Baoqiang(Department of Hepatobiliary Pancreatic Surgery,Anhui NO.2 Provincial People’s Hospital/Anhui Provincial Gallstone Minimally Invasive Diagnosis and Treatment Center,Hefei,Anhui 230041,China)

机构地区：[1]安徽省第二人民医院肝胆胰外科/安徽省胆石症微创诊疗中心,合肥230041

出　　处：《重庆医学》2022年第15期2609-2613,共5页Chongqing medicine

基　　金：安徽省自然科学基金项目(1808085MH237);安徽省高校自然科学研究重点项目(KJ2020A0854);安徽省卫生健康委员会科研项目(2018SEYL004)。

摘　　要：目的探讨回溯手术录像和临床资料回顾性分析的方法评价安全性关键术野(CVS)技术在真实世界中进行腹腔镜胆囊切除术(LC)的应用价值。方法选取2021年1—6月该院收治的行LC并保留完整手术录像资料的患者172例。通过回顾手术录像及临床资料,将患者分为CVS组和未完成CVS(NCVS)组,比较两组不同胆囊炎严重程度的患者在胆囊系膜解剖、重要管道识别、术中胆管损伤(BDI)、手术时间、术后胆漏及住院时间等差异。对影响中/重度胆囊炎实施CVS的危险因素进行logistic回归分析,并绘制受试者工作特征(ROC)曲线判断其预测价值。结果本组LC总体达到CVS的比例为70.93%(122/172),轻/中/重度胆囊炎患者实施CVS的比例分别为85.98%、49.12%、25.00%。CVS组中,不同胆囊炎严重程度的患者均能顺利完成胆囊系膜、胆囊颈管及血管、胆囊床下1/3的显露;NCVS组中,与轻度胆囊炎患者比较,中/重度胆囊炎患者胆囊系膜显露率(80.00%vs.48.57%)、胆囊颈管/血管显露率(73.33%vs.42.86%)较低,胆囊床下1/3显露率(46.67%vs.82.86%)较高,差异均有统计学意义(P<0.05)。针对影响中/重度胆囊炎患者未能完成CVS的原因进行多因素logistic回归分析,结果显示术前白细胞计数(WBC)>18×10^(9)/L、体重指数(BMI)>24 kg/m^(2)、既往行胆囊穿刺、存在胆管变异、胆囊颈管结石嵌顿是其独立危险因素;ROC曲线分析显示,以上危险因素预测CVS实施效果具有良好效能,曲线下面积为0.851。结论CVS技术能够减少BDI发生,中/重度胆囊炎患者实施相对困难,术前评估有助于判断中/重度胆囊炎患者是否能够实施CVS。Objective To evaluate the application value of critical view of safety(CVS)technology for conducting laparoscopic cholecystectomy(LC)in real world by the method of retroactive surgical video recording and clinical data retrospective analysis.Methods A total of 172 patients with LC and retained complete surgical video data in this center from January 2021 to June 2021 were selected.By reviewing the surgical video and clinical data,the patients were divided into the CVS group and non-CVS(NCVS)group.The differences in gallbladder mesangial anatomy,important tube identification,intraoperative bile duct injury(BDI),operation time,postoperative bile leakage and hospital stay in different severities of cholesystitis were compared between the two groups.The Logistic regression analysis was conducted on the risk factors affecting the implementation of CVS in moderate/severe cholecystitis,and the receiver operating characteristic(ROC)curve was drawn to judge its predictive value.Results The proportion of LC totally reaching CVS in this group was 70.93%(122/172),and the proportion of implementing CVC in mild/moderate/severe cholecystitis patients was 85.98%,49.12%and 25.00%,respectively.In the CVS group,the different severities of the patients with cholecystitis could smoothly complete the exposure of gallbladder mesangium,gallbladder cervical canal,blood vessels and 1/3 of gallbladder bed;in the NCVS group,compared with the mild cholecystitis patients,the exposure rates of gallbladder mesangium(80.00%vs.48.57%)and gallbladder neck tube/blood vessel(73.33%vs.42.86%)in the patients with moderate/severe cholecystitis were lower,but the exposure rates of 1/3 under gallbladder bed(46.67%vs.82.86%)was higher,and the difference was statistically significant(P<0.05).The multivariate logistic regression analysis was conducted on the factors of failure to complete CVC in the patients with moderate/severe cholesystitis and the results showed that the preoperative WBC count>18×10^(9)/L,BMI>24 kg/m^(2),previous gallbladder puncture an

关 键 词：回溯 手术录像 安全性关键术野 腹腔镜胆囊切除术 胆管损伤 胆囊炎症程度 

分 类 号：R657.4[医药卫生—外科学]