【摘要】 目的探讨急性胆囊炎腹腔镜胆囊切除术(LC)成功的影响因素和手术时机的选择。方法回顾性分析2013年1月1日—2016年12月31日因急性胆囊炎行急诊LC的患者1 025例。其中按计划完整切除胆囊973例,未按计划施行完整胆囊切除(包括中转开腹手术、腹腔镜下胆囊大部切除术和单纯胆囊造瘘术)52例。采用χ~2检验和多因素logistic回归分析未按原计划在腹腔镜下完整切除胆囊的影响因素。比较手术时距起病≥72h和<72h患者的手术时间、术中出血量、手术中转率和术后并发症发生情况。结果χ~2检验结果显示,体温≥38.5℃、胆囊周围有积液、胆囊壁厚度≥6mm、胆囊颈部结石嵌顿、有反复发作史、手术时距起病≥72h、术前白细胞计数≥15×10~9/L均与手术中转率显著相关(P值分别<0.05、0.01)。多因素logistic回归分析结果显示,术前白细胞计数≥15×10~9/L(OR=2.877,95%CI为1.531~3.934)、胆囊壁厚度≥6 mm(OR=2.221,95%CI为1.503~3.565)和胆囊颈部结石嵌顿(OR=1.947,95%CI为1.458~3.121)是影响LC中转的独立危险因素(P值均<0.001)。手术时距起病≥72h者的手术时间、术中出血量、中转行腹腔镜下胆囊大部切除或造瘘术率均显著高于手术时距起病<72h者(P值均<0.05)。结论术前白细胞计数、胆囊壁厚度和胆囊颈部结石嵌顿是急性胆囊炎患者成功施行LC的影响因素。发病超过72h者行LC的手术操作难度增加、手术时间延长,但并非手术禁忌。更多还原

【Abstract】 Objective To explore the risk factors and operation timing of laparoscopic cholecystectomy for acute cholecystitis.Methods A total of 1 025 patients undergoing emergency laparoscopic surgery for acute cholecystitis from January 1,2013 to December 31,2016 were retrospectively analyzed.Laparoscopic cholecystectomy was accomplished in 973 patients,while the procedure was not completed in the other 52 patients(including conversion to open surgery,laparoscopic subtotal cholecystectomy and laparoscopic cholecystostomy).Chi-square test and multivariate logistic analysis were used to analyze the risk factors of troubled cholecystectomy.Operation time,blood loss,conversion rate and postoperative complications were compared between patients with onset time ≥72 hand <72 h.Results The results showed that body temperature≥38.5 ℃,fluid around the gallbladder,thickening of the gallbladder≥6 mm,neck stone incarceration,recurrent history,operation timing≥72 h,and white blood cell count≥15×10~9/L were significantly correlated with the change of surgical methods(P<0.05,0.01).Multivariate logistic analysis showed that white blood cell count≥15×10~9/L(OR=2.877,95%CI:1.531-3.934),gallbladder wall thickness≥6 mm(OR=2.221,95%CI:1.503-3.565)and neck stone incarceration(OR =1.947,95% CI:1.458-3.121)were independent risk factors for successful laparoscopic cholecystectomy(all P<0.001).The patients with onset time ≥72 hhad longer operation time,more intraoperative blood loss and higher conversion rate than those with onset time <72 h(all P<0.05).Conclusion The success of laparoscopic cholecystectomy for acute cholecystitis is associated with white blood cell count,gallbladder wall thickness and neck stone incarceration.When the onset of the disease is more than 72 hours,the difficulty and duration of operation will increase,but it is not a contraindication of the operation.更多还原