【摘要】 目的 :探讨急性胆囊炎腹腔镜胆囊切除术 (LC)的危险因素。方法 :采用非条件Logistic回归 (forward)对 15 3例急性胆囊炎LC的临床指标进行多因素分析。结果 :本组 15 3例病人中 12 5例LC成功 ,2 8例中转开腹 (18.30 % )。急性胆囊炎LC失败的危险因素有上腹部手术史或发作史 ,右上腹肌紧张 ,白细胞增高 ,胆囊管结石嵌顿 ,胆囊图象缺失 ,发病超过 72h。术中发现胆囊三角致密粘连 ,解剖结构不清 ,是中转开腹的绝对指征。结论 :急性胆囊炎LC的危险因素计分有助于外科医生在术前对病人进行全面评估 ,以提高LC的成功率 ,减少并发症的发生。更多还原

【Abstract】 Objective:To explore the risk factors for laparoscopic cholecystectomy (LC) for acute cholecystitis.Methods:The LC clinical data on 153 patients with acute cholecystitis were summarized and analyzed by stepwise logistic regression(forward).Results:It was found that among the 153 cases of acute cholecystitis,125 underwent laparoscopic cholecystectomy successfully and 28(18.30%) had conversion to open cholecystectomy.The risk factors for unsuccessful LC in acute cholecystitis included previous upper abdominal operation or recurrence history,rigidity in right upper abdomen,leukocytosis,stone incarceration on the neck of the gallbladder and no visualization of the gallbladder sonographically,more than 72 hours of onset of symptomatic cholelithiasis.In addition,conversion to open cholecystectomy should be made unconditionally,once intensive dense adhesion and unclear discrimination of Calot′s triangle happened for the duration of LC.Conclusion:The risk score for LC in acute cholecystitis in the study is helpful for evaluating completely the patients of LC before operation,and for increasing success rate and decreasing complication incidence of LC.更多还原