腹腔镜胆囊切除术难度评分系统在急性胆囊炎治疗中的应用价值  

Application values of difficulty scoring system of laparoscopic cholecystectomy for acute cholecystitis

作　　者：孟塬[1] 巴合提·卡力甫[1] 马志刚[1] 王锦国 张杰[1] 李玉鹏 宋巍[1] 田广磊[1] 陈雄[1] Yuan Meng;Baheti·Kalifu;Zhigang Ma;Jinguo Wang;Jie Zhang;Yupeng Li;Wei Song;Guanglei Tian;Xiong Chen(Department of Hepatobiliary Surgery,People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China)

机构地区：[1]新疆维吾尔自治区人民医院肝胆外科,乌鲁木齐830001

出　　处：《中华肝脏外科手术学电子杂志》2024年第2期169-175,共7页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：新疆维吾尔自治区区域协同创新专项——科技援疆计划项目(2022E02133)。

摘　　要：目的:探讨腹腔镜胆囊切除术难度评分系统(DiLCs)在急性胆囊炎腹腔镜胆囊切除术(LC)治疗中的应用价值。方法:回顾性分析2016年5月至2019年1月在新疆维吾尔自治区人民医院行LC的158例急性胆囊炎患者临床资料。其中男88例,女70例;平均年龄(60±18)岁。患者均签署知情同意书,符合医学伦理学规定。分别采用DiLCs评分系统和急性胆囊炎京东指南2018(TG18)分级系统对患者围手术期指标进行分析,两个分级系统与临床指标相关性分析采用单因素方差分析、秩和检验等;采用ROC曲线下面积(AUC)对两个系统进行比较。结果:随着两种评分系统评分增加,WBC、手术时间、术中出血量、住院时间、胆囊造瘘率、中转开腹率等急性胆囊炎相关指标增加,差异有统计学意义(P<0.05)。TG18和DiLCs评估并发症的AUC分别为0.889(95%CI:0.829~0.933)和0.509(95%CI:0.428~0.598),TG18明显优于DiLCs(Z=3.795,P<0.05)。DiLCs和TG评估中转开腹率的AUC分别为0.697(95%CI:0.619~0.768)和0.746(95%CI:0.670~0.811),差异无统计学意义(Z=0.829,P>0.05)。DiLCs和TG评估胆囊造瘘率的AUC分别为0.664(95%CI:0.584~0.737)和0.770(95%CI:0.697~0.833),差异无统计学意义(Z=1.639,P>0.05)。结论:DiLCs可有效评估患者手术难度和治疗方式选择,其评估能力与TG18一致,而在手术风险预测等方面弱于TG18。Objective To evaluate the operative difficulty scoring system of laparoscopic cholecystectomy(DiLCs)for acute cholecystitis.Methods Clinical data of 158 patients with acute cholecystitis who underwent LC in People's Hospital of Xinjiang Uygur Autonomous Region from May 2016 to January 2019 were retrospectively analyzed.Among them,88 patients were male and 70 female,aged(60±18)years on average.The informed consents of all patients were obtained and the local ethical committee approval was received.DiLCs scoring system and Tokyo Guidelines 2018(TG18)for acute cholecystitis were adopted to analyze the perioperative indexes of patients.The correlation between two grading systems and clinical indexes was analyzed by single-factor analysis of variance(ANOVA)and rank-sum test.The area under ROC curve(AUC)was employed to compare two scoring systems.Results With the increase of the scores of two scoring systems,WBC,operation time,intraoperative blood loss,length of hospital stay,gallbladder fistula rate,conversion rate to open surgery and other indexes related to acute cholecystitis were also increased,and the differences were statistically significant(P<0.05).The AUC of TG18 and DiLCs in evaluating complications was 0.889(95%CI:0.829-0.933)and 0.509(95%CI:0.428-0.598),and the AUC of TG18 was significantly higher compared with that of DiLCs(Z=3.795,P<0.05).The AUC of DiLCs and TG in evaluating conversion rate to open surgery was 0.697(95%CI:0.619-0.768)and 0.746(95%CI:0.670-0.811),and the difference was not statistically significant(Z=0.829,P>0.05).The AUC of DiLCs and TG in evaluating gallbladder fistula rate was 0.664(95%CI:0.584-0.737)and 0.770(95%CI:0.697-0.833),and the difference was not statistically significant(Z=1.639,P>0.05).Conclusions DiLCs can effectively evaluate the difficulty of LC and the selection of therapeutic options.The evaluation capability of DiLCs is consistent with that of TG18,while weaker in predicting surgical risk.

关 键 词：急性胆囊炎 胆囊切除术 腹腔镜 手术难度 评分系统 

分 类 号：R657.41[医药卫生—外科学]