摘要
目的：分析术前预测急症腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）中转开腹的可能性,以期找到客观、实用、准确率高的预测LC手术难易度的方法,并选择适当的手术方式。方法：回顾分析2005~2009年120例急症LC中38例中转开腹患者的临床资料。从胆囊炎、胆囊结石疾病病理方面提取胆囊炎发作时间、胆囊三角解剖层次、胆囊壁厚度、胆囊结石是否嵌顿、是否为坏疽性胆囊炎等5种因素。用Stata 10.0统计软件分析,单因素分析找出影响急症LC中转开腹的危险因素,多因素分析建立Logistic回归方程,进行急症腹腔镜胆囊切除术中转开腹可能性预测,并评估预测效能。结果：120例患者行急症LC,其中38例中转开腹,中转率31.67%。单因素分析表明,胆囊炎发作〉72h,胆囊三角解剖不清,胆囊壁厚度〉0.5cm,坏疽性胆囊炎均是腹腔镜胆囊切除术中转开腹的相关危险因素。Logistic回归分析结果表明,胆囊炎发作〉72h,胆囊三角解剖不清,胆囊壁厚度〉0.5cm,坏疽性胆囊炎为腹腔镜胆囊切除术中转开腹的危险因素。建立Logistic回归方程进行预测,预测效能0.9519。结论：胆囊炎发作〉72h,胆囊三角解剖不清,胆囊壁厚度〉0.5cm,坏疽性胆囊炎是中转开腹的危险因素。患者含有上述危险因素越多,手术难度越大,中转开腹的可能性越大。因此,术前综合评估患者具有的危险因素对选择手术方案,降低中转开腹率有较高的临床指导意义,可避免单纯追求LC带来的严重并发症。
Objective：To investigate the predictive possibility of convertion from emergency laparoscopic cholecystectomy（LC） to open operation to find a practical and effective approach to select appropriate patients for LC.Methods：Medical data of 120 patients who underwent emergency LC from 2005 to 2009 were analyzed retrospectively.From the pathological aspects and of cholecystitis and gallbladder stone disease onset time of cholecystitis,gallbladder triangle anatomical levels,gallbladder wall thickness,gallstone incarceration and gangrenous cholecystitis were extracted as the five factors.With Stata 10.0 statistical analysis software,single factor analysis was made to identify the risk factor of emergency LC convertion to open surgery,multiple logistic regression equation of factor analysis was made to predict the possibility of emergency laparoscopic cholecystectomy convertion to open operation and evaluate the efficiency.Results：One hundred and twenty cases underwent emergency LC,of which 38 cases were converted to open cholecystectomy,conversion rate was 31.67%.Univariate analysis showed that cholecystitis attack72h,gallbladder triangle indistinct anatomy,gallbladder wall thickness0.5cm and gangrenous cholecystitis were correlate risk factor of LC conversion to open surgery.Logistic regression analysis showed that cholecystitis attack72h,gallbladder triangle indistinct anatomy,gallbladder wall thickness0.5cm and gangrenous cholecystitis were risk factors of LC convertion to open surgery.Logistic regression equation showed predictive efficiency was 0.9519.Conclusions：Cholecystitis attack72h,gallbladder triangle indistinct anatomy,gallbladder wall thickness0.5cm,gangrenous cholecystitis are risk factors of conversion to laparotomy.LC patients has the more risk factors,the difficulty of operation is greater,the possibility of conversion to open surgery is higher.Preoperative comprehensive evaluation of risk factor is significant for choosing operative method and decreasing conversion rate,can avoid serious complications of LC.
出处
《腹腔镜外科杂志》
2011年第6期450-456,共7页
Journal of Laparoscopic Surgery
关键词
胆囊炎
胆囊结石病
胆囊切除术
腹腔镜
回顾性研究
危险因素
Cholecystitis
Cholecystolithiasis
Cholecystectomy
laparoscopic
Retrospective studies
Risk factors
