【摘要】 目的:分析腹腔镜胆囊切除术中转开腹的原因及相关危险因素,为外科医生的临床决策提供参考。方法:回顾分析3 476例腹腔镜胆囊切除术患者的临床资料,采用单因素分析及多因素logistic回归分析,探讨影响中转开腹的危险因素,并用SPSS 13.0绘制历年中转开腹率趋势图。结果:3 476例患者中,163例中转开腹,中转开腹率为4.7%;中转开腹组与腹腔镜组手术时间、术中出血量、术后住院时间、术后排气时间差异有统计学意义(P<0.05);胆囊粘连严重、胆囊三角处理困难是中转开腹的主要原因,占所有因素的57.1%;单因素分析结果显示:肥胖、手术经验、腹部手术史、胆囊炎反复发作史、胆囊壁厚度、WBC计数与腹腔镜胆囊切除术中转开腹相关(P<0.05);多因素分析结果显示:腹部手术史、肥胖、胆囊炎反复发作史、手术经验、胆囊壁厚度是影响腹腔镜胆囊切除手术中转开腹的独立危险因素(P<0.05)。结论:术前正确评估腹腔镜胆囊切除术中转开腹的相关危险因素,可为外科医生术中决策提供一定的参考,并可减少手术并发症。更多还原

【Abstract】 Objective: The aim of this study is to analyze the reasons and risk factors of intraoperative conversion from laparoscopic cholecystectomy to open cholecystectomy,and provide a reference for surgeons. Methods: Retrospective analysis was performed on the clinical data of 3 476 patients,who underwent laparoscopic cholecystectomy. Risk factors were evaluated by univariate analysis and logistic multiple regression analysis. A trend graph of conversion rate over the years was drawn by SPSS 13. 0. Results: In the 3 476 patients,163 of them were converted to open cholecystectomy,the overall conversion rate was 4. 7%; The operative time,blood loss,postoperative hospital stay and exsufflation time showed significant differences between conversion and laparoscopy group( P < 0. 05);The most common reason for conversion was adhesions and difficult dissection at the Calot triangle,accounting for 57. 1% of all the factors. The factors affecting conversion rate which were found to be significant by univariate analysis included: obesity,experience of operators,history of abdominal surgery,history of repeated acute cholecystitis,gallbladder wall thickness,white blood cell count( P< 0. 05). The independent risk factors of laparoscopic cholecystectomy converted to open surgery which were found by multiple-factors included previous abdominal surgery,obesity,history of repeated cholecystitis,experience of operators,gallbladder wall thickness( P <0. 05). Conclusions: Correct assessment of risk factors for conversion of laparoscopic cholecystectomy to laparotomy can provide a reference for surgeons,and reduce complications.更多还原