Objective To analyze the influencing factors of conversion from laparoscopic surgery to laparotomy in patients with acute calculous cholecystitis.Methods 600 patients with acute calculous cholecystitis treated by laparoscopic surgery in the hospital were selected.According to the time interval from the onset of clinical symptoms to laparoscopic surgery,the patients were divided into group A (within 48 hours after onset),group B (48 hours after onset) and group C (1-2 weeks after symptom relief),with 200 cases in each group.The duration of surgery,intraoperative blood loss,postoperative drainage volume,the incidence of complications and the rate of conversion to laparotomy were recorded.Patients undergoing laparotomy were included into the observation group and the others were included into the control group.The clinical data were compared between the two groups,and the independent risk factors for conversion to laparotomy were analyzed.Results The surgical time,intraoperative blood loss and postoperative abdominal drainage volume of group B were significantly longer or more than those of group A and those of group C (P＜0.05).The rate of conversion to laparotomy and the incidence of complications were lower in group A than in group B or in group C (P＜0.05).The body temperature,white blood cell count,thickness of gallbladder wall,surgical time,incidence rates of gallbladder neck calculi incarceration and gallbladder enlargement were significantly higher,thicker or longer in the observation group than in the control group (P＜0.05).Logistic regression analysis showed that white blood cell count,timing of surgery and gallbladder neck calculi incarceration were independent risk factors for conversion to laparotomy (P＜0.05).Conclusion Within 48h after the onset of acute calculous cholecystitis is the best timing for laparoscopic surgery.White blood cell count,timing of surgery and gallbladder neck calculi incarceration are independent risk factors for conversion to laparotomy,which should be considered to improve the success rate of laparoscopic surgery.%目的 探讨影响急性结石性胆囊炎患者腹腔镜手术中转开腹的因素.方法 选取入院行急性结石性胆囊炎腹腔镜手术的患者600例,根据临床症状发生至开始腹腔镜手术时间间隔分为A组、B组、C组,每组各200例,三组手术时间分别为症状发作48h内和48h后、行抗感染及对症支持等保守治疗至症状缓解1～2周,记录三组手术时间、术中出血量、术后腹腔引流量、并发症发生率、中转开腹率,并将中转开腹患者117例纳入观察组,其余483例纳入对照组,比较两组临床资料,分析影响中转开腹的独立危险因素.结果 B组手术时间、术中出血量、术后腹腔引流量与A、C组比较均明显较高(P＜0.05);A组中转开腹率、并发症发生率均较B、C组低(P＜0.05);观察组体温、白细胞计数、胆囊壁厚度、手术时间、胆囊颈部结石嵌顿、胆囊肿大均明显高于对照组(P＜0.05).Logistic回归分析显示白细胞计数、手术时机、胆囊颈部结石嵌顿是影响患者中转开腹的独立危险因素(P＜0.05).结论 急性结石性胆囊炎发作后48h内是进行腹腔镜手术的最佳时机,白细胞计数、手术时机、胆囊颈部结石嵌顿是影响中转开腹的独立危险因素,应综合考虑提高腹腔镜手术成功率.
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