腹腔镜脾脏切除术中转开腹的相关因素分析

摘要

Objective To reduce the conversion rate of laparoscopic splenectomy,and to probe related factors of conversion to open procedure for laparoscopic splenectomy.Methods A retrospective analysis of the clinical data for patients who received laparoscopic splenectomy (LS) was made from October 1997 to December 2010 at the Department of General Surgery,Sir Run Run Shaw Hospital.Results There were 177 cases initially receiving laparoscopic splenectomy,32 cases were converted to open splenectomy with a conversion rate of 18.1％.The main reason was unexpected massive bleeding (38.0％,62/177).The conversion rate varied with different diseases (P ＜ 0.01),the portal hypertension group had the highest rate (35.7％,20/56).The conversion rate in normal size group,moderately splenomegaly group,Huge spleen group were statistically different (P ＜ 0.01).The conversion rate varied significantly with surgeons expertise (P ＜ 0.05).Conclusion Bleeding is the main reason for laparoscopic splenectomy converting to open splenectomy.Portal hypertension has the highest conversion rate.%目的 通过大宗病例分析腹腔镜脾脏切术中转开腹的原因及相关因素,探讨降低中转开腹率的措施.方法 回顾性分析1997年10月至2010年12月在浙江大学医学院附属邵逸夫医院普外科接受腹腔镜脾脏切除术(laparoscopic splenectomy,LS)患者的临床资料,分析中转开腹的原因.按不同病种、脾脏大小及手术者分组分别进行研究.本组分类资料采用X2检验,组间比较计量资料采用t检验(方差不齐的采用秩和检验),多因素分析采用Logistic回归分析.所有数据采用SPSS 13.0 for windows统计软件进行处理. 结果 全组177例,中转开腹32例,中转开腹率为18.1％.术中意外出血占38.0％(62/177),是中转开腹的主要原因.不同病种各组中转开腹率有显著差异(x2=18.21,P＜0.01).其中门静脉高压组中转率最高,达35.7％(20/56).脾脏大小与中转开腹率相关(X2=7.23,P＜0.05).手术者与中转开腹率存在相关性(x2 =31.61,P＜0.01).Logistic回归分析表明,不同病种各组之间手术中转率的差异有统计学意义(P =0.009).结论 术中意外出血是腹腔镜脾脏切除术中转开腹的主要原因.肝硬化门静脉高压症行腹腔镜脾脏切除术存在较高的中转风险.