腹腔镜胆囊切除术中转开腹手术原因及危险因素分析

摘要

Objective To explore the cause and risk factors of conversion to open operation in the process of laparoscopic cholescytectomy(LC).Methods A total of 498 patients underwent LC in Depart-ment of General Surgery,Nongken General Hospital of Hainan Province from Jan.2010 to Mar.2014 were selected,including 45 cases of conversion to open operation in the process of LC as the case group,and the other 453 cases as the control group.Causes and risk factors of conversion to open operation in the process of LC were analyzed.Results The incidence rate of conversion to open operation in the process of LC was 9.0%(45/498).The risk factors of conversion to open operation in the process of LC included the history of acute cholecystitis(OR=5.244,95%CI 3.589-6.898),leucocyte count before operation(OR =1.994, 95%CI 1.386-2.601),positive Murphy sign(OR=6.449,95%CI 4.225-8.674),thickness of gallbladder (OR=4.175,95%CI 2.744-5.605),gallbladder neck stone impaction(OR =3.114,95%CI 2.079-4.149) and technical level of operators(OR=0.131,95%CI 0.131-0.582).Conclusion The incidence rate of conversion to open operation in the process of LC is still a little higher ,and there are many causes and risk factors affecting the happening of this conversion .So it is significant to adopt neccessary prevention meas-ures concerning these risk factors,in order to reduce the incidence rate of complications.%目的：探讨腹腔镜胆囊切除术（ LC ）中转开腹手术的原因及其危险因素。方法选择2010年1月至2014年3月在海南省农垦总医院普外科行 LC 的病例498例， LC 中转开腹病例有45例作为病例组，其余453例作为对照组，分析影响中转开腹手术的原因及其危险因素。结果 LC中转开腹手术发生率为9.0％（45／498）；影响中转开腹手术的危险因素包括急性胆囊炎次数（ OR＝5.244，95％CI 3.589～6.898）、术前白细胞计数（ OR＝1.994，95％CI 1.386～2.601）、Murphy征阳性（OR＝6.449，95％CI 4.225～8.674）、胆囊壁厚度（OR＝4.175，95％CI 2.744～5.605）、胆囊颈部结石嵌顿（OR＝3.114，95％CI 2.079～4.149）、手术者技术水平（OR ＝0.131，95％CI 0.131～0.582）。结论 LC中转开腹手术的发生率仍然较高，影响中转开腹手术的原因和危险因素较多，应针对这些因素采取必要的预防措施，从而降低并发症的发生率。