腹腔镜胆囊切除中转开腹的若干因素分析

发布时间：2018-11-23 06:28

【摘要】：目的:分析腹腔镜胆囊切除术(Laparoscopic cholecystectomy LC)可能导致中转开腹的若干危险因素,指导术前准备及术中备案,进一步减低开腹率。方法:通过收集2010年-2016年我院733例腹腔镜胆囊切除病人相关临床数据,回顾性对比分析可能导致术中中转开腹的相关危险因素。结果:我院733例胆囊切除病人中成功行腹腔镜胆囊切除病人704例(96%),29例中转开腹(4%)。中转开腹组中病理证实急性胆囊炎21例,占比72.4%。慢性胆囊炎5例,占比17.3%。急性化脓化脓坏疽性胆囊炎3例,占比10.3%。中转开腹原因中因急性期组织水肿严重,组织分离困难13例,占比43.3%。胆囊颈部多发结石至胆囊三角分离困难3例,占比10%。因胆囊炎反复发作致胆囊三角粘连致密分离困难6例,占比20%。上腹部腹腔广泛粘连6例,占比20%。内脏转位1例,占比3.3%。在中转开腹组单因素卡方检验中男性、白细胞升高、厚壁胆囊(4mm)、胆囊颈部结石、胆囊急性发作(72h)、谷丙转氨酶升高、总胆红素升高、糖尿病、上腹部手术病史等因素具有统计学差异(P0.05)。年龄、术前白蛋白水平、AST、胆囊结石大小未见明显统计学差异(P0.05).在多因素回归分析中发现胆囊颈部结石、胆囊急性发作(72h)、胆囊壁增厚(4mm)、总胆红素升高、糖尿病5种危险因素是腹腔镜胆囊切除的独立危险因素(OR1)。结论:导致腹腔镜胆囊切除中转开腹的危险因素包括:胆囊壁增厚、总胆红素升高、胆囊炎急性期(72h)、胆囊颈部结石、糖尿病5种。临床医师术前应仔细评估上述危险因素,进一步降低中转开腹率,减少术后并发症的出现。
[Abstract]:Objective: to analyze the risk factors of laparoscopic cholecystectomy (Laparoscopic cholecystectomy LC) which may lead to conversion to open operation, to guide preoperative preparation and intraoperative record, and to further reduce the rate of laparotomy. Methods: the clinical data of 733 patients undergoing laparoscopic cholecystectomy from 2010 to 2016 were collected and analyzed retrospectively. Results: of the 733 cases of cholecystectomy, 704 cases (96%) were successfully treated with laparoscopic cholecystectomy and 29 cases (4%) were converted to open cholecystectomy. 21 cases (72.4%) of acute cholecystitis were confirmed by pathology in the group of conversion to laparotomy. There were 5 cases of chronic cholecystitis, accounting for 17.3%. There were 3 cases of acute pyogenic gangrenous cholecystitis (10.3%). 13 cases (43.3%) were difficult in tissue separation because of severe edema in acute stage. There were 3 cases with difficulty in separating multiple gallstones from gallbladder neck to the triangle of gallbladder, accounting for 10%. There were 6 cases (20%) with difficulty in dense separation of cholecystitis caused by cholecystitis. There were 6 cases (20%) with extensive adhesion in the epigastric abdomen. The visceral transposition occurred in 1 case (3.3%). In the univariate chi-square test of the conversion group, leukocyte increased, thick-walled gallbladder (4mm), gallbladder neck stone, acute gallbladder attack (72 h), alanine aminotransferase (alt), total bilirubin (Tbilirubin) increased, diabetes mellitus (DM). The history of epigastric surgery had statistical difference (P0.05). Age, preoperative albumin level, AST, gallstone size no significant difference (P0.05). In multivariate regression analysis, five risk factors of cholecystolithiasis, acute gallbladder attack (72 h), gallbladder wall thickening (4mm), total bilirubin increase and diabetes mellitus were found to be independent risk factors (OR1) for laparoscopic cholecystectomy. Conclusion: the risk factors leading to the conversion of laparoscopic cholecystectomy include thickening of gallbladder wall, increase of total bilirubin, acute stage of cholecystitis (72 h), gallbladder neck stone and diabetes mellitus. The risk factors mentioned above should be carefully evaluated before operation to further reduce the rate of conversion to laparotomy and the occurrence of postoperative complications.
【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.4

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