腹腔镜胆囊切除术中转开腹评估体系的建立及手术分级管理探索  

Establishment of an evaluation system for conversion to laparotomy in laparoscopic cholecystectomy and explora⁃tion of surgical grading management

作　　者：张男男 郭金星 吴钢 易辉 周远航 廖芝伟 黄琦 董建 ZHANG Nannan;GUO Jinxing;WU Gang;YI Hui;ZHOU Yuanhang;LIAO Zhiwei;HUANG Qi;DONG Jian(Department of General Surgery,Renhe Hospital,Baoshan District,Shanghai 200431,China;Department of Hepatobiliary Pancreatic Surgery,Renhe Hospital,Baoshan District,Shanghai 200431,China;Department of General Surgery,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]上海市宝山区仁和医院肝胆胰外科,上海200431 [2]上海市宝山区仁和医院普外科,上海200431 [3]复旦大学附属华山医院普外科,上海200040

出　　处：《外科理论与实践》2025年第1期54-60,共7页Journal of Surgery Concepts & Practice

基　　金：上海市宝山区科学技术委员会科技创新专项资金项目(18-E-15);上海市宝山区仁和医院中青年优秀人才培养计划(BSRHYQ-2021-01)。

摘　　要：目的:探讨并建立一个根据术前临床资料预测腹腔镜胆囊切除术(LC)中转开腹可能性的评分体系并以此建立手术分级管理模式。方法:回顾性研究仁和医院及华山医院2013年6月至2018年6月9414例行LC病人的临床资料,分为LC组(9246例)和中转开腹组(168例),将两组资料进行比较,用卡方检验单因素分析筛选出影响中转开腹的危险因素,再对危险因素行Logistic多元回归分析,并根据所建中转开腹可能性函数对危险因素各变量前系数进行赋值,计算每个病例的得分后,比较各得分组的实际中转开腹率的差异。计算受试者工作特征(ROC)曲线下面积评价该评分系统的效能。根据评分体系同时创建LC手术分级管理模式并进行验证。结果:体温≥38.5℃、急性胆囊炎发作次数≥3次、胆囊壁最大厚度≥5 mm、胆囊颈部结石嵌顿、胆总管直径≥8 mm、术者经验≤50例是中转开腹的危险因素(P<0.001)。评分系统>3分,中转开腹风险高。结论:该LC评分体系及手术分级管理可靠有效,可降低LC中转开腹率。Objective To develop and validate a scoring system to predict the possibility of laparoscopic cholecystectomy(LC)conversion to laparotomy based on preoperative clinical data,and to establish a grading management model of surgery.Methods A retrospective analysis was conducted on the clinical data of 9414 patients who underwent LC at Renhe Hospital and Huashan Hospital from June 2013 to June 2018.The patients were divided into two groups:the LC group(9246 patients who successfully underwent LC)and the conversion to laparotomy group(168 patients who required conversion to open surgery).The data of two groups were compared,and the risk factors affecting conversion to laparotomy were screened out by single factor analysis of Chi-square test.Then,the risk factors were analyzed by multiple Logistic regression,and the pre-coefficient of each variable of the risk factors was assigned according to the established conversion to laparotomy possibility function.After calculating the score of each case,the difference in the actual conversion rate of each group was compared.The area under receiver operating characteristic(ROC)curve was calculated to evaluate the performance of the scoring system.According to the scoring system,LC surgical grading management model was created and verified.Results The following factors were identified as significant risk factors for conversion to laparotomy(P<0.001):body temperature≥38.5℃,frequency of acute cholecystitis≥3 times,maximum thickness of gallbladder wall≥5 mm,gallbladder neck stone incarceration,diameter of common bile duct≥8 mm,and surgical experience≤50 cases were the risk factors for conversion to laparotomy(P<0.001).A score>3 points was associated with a high risk of conversion to laparotomy.Conclusions The LC scoring system and surgical grading management are reliable and effective tools for predicting and reducing the conversion rate of LC to laparotomy.

关 键 词：腹腔镜 胆囊切除术 中转开腹 危险因素 评分系统 

分 类 号：R657.4[医药卫生—外科学] R575.6[医药卫生—临床医学]