摘要
目的探讨急性结石性胆囊炎患者行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中转开腹的危险因素。方法通过青海省人民医院医院管理信息系统(hospital management information system,HIS)收集青海省人民医院普外科2018年1月至2019年12月急性结石性胆囊炎行LC患者的临床资料,探讨LC中转开腹的独立危险因素,行单因素分析和二元多因素Logistic回归分析影响因素。结果共收集156例急性结石性胆囊炎患者基本资料及临床资料,其中完全行LC者共120例,由腹腔镜中转开腹手术胆囊切除术有36例,纳入研究影响因素中性别(χ^2=0.414,P=0.520)、年龄(χ^2=0.309,P=0.578),体质指数(χ^2=0.001,P=0.977)、高血压病(χ^2=1.256,P=0.262)差异均无显著性;胆囊壁厚度(χ^2=15.230,P<0.001)、胆囊炎急性发作时间(χ^2=6.984,P=0.008)、白细胞计数(Z=-2.533,P=0.011)、总胆红素水平(Z=-2.311,P=0.021)和纤维蛋白原(Z=-2.490,P=0.013)差异均有显著性。行二元多因素Logistic回归结果表明,胆囊壁厚度≥5mm、胆囊炎急性发作时间≥72h是急性结石性胆囊炎LC术中转开腹的独立危险因素。结论 LC术前准确把握手术适应证,术中规范、细致的操作可有效降低LC中转开腹率,而当患者术前超声提示胆囊壁显著增厚或胆囊炎急性发作时间较长应提前做好中转开腹的准备,以降低手术时间。
Objective To explore the risk factors of laparoscopic cholecystectomy(LC)to laparotomy in patients with acute calculous cholecystitis.Methods Clinical data of LC patients with acute calculous cholecystitis from January 2018 to December 2019 were collected from the general surgery department of Qinghai People’s Hospital through the hospital management information system(HIS),and to explore the independent risk factors of LC conversion to laparotomy,univariate analysis and binary multivariate Logistic regression analysis were performed to analyze the influencing factors.Results The basic and clinical data of 156 patients with acute calculous cholecystitis were collected,and a total of 120 cases were totally treated by laparoscopic cholecystectomy,but 36 cases were transferred from laparoscopic to open cholecystectomy.There were no significant differences in gender(χ^2=0.414,P=0.520),age(χ^2=0.309,P=0.578),body mass index(χ^2=0.001,P=0.977),and hypertension(χ^2=1.256,P=0.262).There were significant differences in gallbladder wall thickness(χ^2=15.230,P<0.001),acute onset time of cholecystitis(χ^2=6.984,P=0.008),leukocyte count(Z=-2.533,P=0.011),total bilirubin level(Z=-2.311,P=0.021)and fibrinogen(Z=-2.490,P=0.013).The results of binary multivariate Logistic regression showed that the thickness of gallbladder wall≥5mm and the time of acute onset of cholecystitis≥72h were independent risk factors for LC conversion to laparotomy in acute calculous cholecystitis.Conclusion Preoperative accurate and strict analysis of the indications of LC surgery,intraoperative norms and careful operation can effectively reduce the conversion rate of laparotomy,and when preoperative ultrasound suggests significant thickening of the gallbladder wall or longer acute onset of cholecystitis should be prepared in advance for conversion to laparotomy,in order to reduce the operation time.
作者
冯少培
郭亚民
韩秀敏
Feng Shaopei;Guo Yamin;Han Xiumin(Graduate School of Qinghai University,Xining 810001,Qinghai;General Surgery Department of Qinghai Provincial People’s Hospital,Xining 810001,Qinghai)
出处
《临床普外科电子杂志》
2020年第4期3-7,共5页
Journal of General Surgery for Clinicians(Electronic Version)
关键词
腹腔镜胆囊切除术
急性胆囊炎
中转开腹
胆囊结石
Laparoscopic cholecystectomy
Acute cholecystitis
Laparotomy
Cholecystolithiasis
