腹腔镜胆囊切除术联合腹腔镜胆总管探查术中转开腹的 危险因素探讨及临床分析
| 作者: |
1姚宇驰,
1商中华
1 山西医科大学第二临床医学院 / 山西医科大学第二医院 普通外科，山西 太原 030000 |
| 通讯: |
商中华
Email: shangzhonghua2001@163.com |
| DOI: | 10.3978/.2018.08.007 |
摘要
目的：探讨行腹腔镜胆囊切除术（LC）联合腹腔镜胆总管探查术（LCBDE）治疗胆囊结石合并胆总管结石时中转开腹的危险因素并进行相关临床分析。
方法：回顾性分析 2014 年 1 月—2018 年 6 月期间 197 例行 LC+LCBDE 患者的临床资料，筛选中转开腹手术的危险因素，并比较完成腹腔镜手术患者与中转开腹患者围术期指标及术后并发症情况。
结果：197 例中 15 例（7.6%）中转开腹。单因素与多因素回归分析结果显示，血清总胆红素 >17.1 µmol/L （OR=5.156，P=0.032）、胆囊壁厚度 >6 mm（OR=7.971，P=0.012）、黄疸（OR=10.715，P=0.002）、胆总管下段结石嵌顿（OR=20.203，P=0.003）是中转开腹的独立危险因素。以上 4 种因素组合所建立回归方程预测中转开腹的 ROC 曲线下面积为 0.891，敏感度为 80.0%，特异度为 98.9%。与中转开腹患者比较，完成腹腔镜手术患者手术时间、术中出血量、术后镇痛剂使用次数、术后抗生素使用时间、术后肛门排气时间、住院时间、住院费用、并发症发生率均明显减少（均 P<0.05）。
结论：对于 LC+LCBDE 患者，应仔细评估上述 4 种独立危险因素，这对于完善术前准备、选择手术方式，降低开放手术转化率，以及改善患者预后具有重要意义。
关键词：
胆总管结石病；胆囊结石病；腹腔镜；中转开腹手术；危险因素
方法：回顾性分析 2014 年 1 月—2018 年 6 月期间 197 例行 LC+LCBDE 患者的临床资料，筛选中转开腹手术的危险因素，并比较完成腹腔镜手术患者与中转开腹患者围术期指标及术后并发症情况。
结果：197 例中 15 例（7.6%）中转开腹。单因素与多因素回归分析结果显示，血清总胆红素 >17.1 µmol/L （OR=5.156，P=0.032）、胆囊壁厚度 >6 mm（OR=7.971，P=0.012）、黄疸（OR=10.715，P=0.002）、胆总管下段结石嵌顿（OR=20.203，P=0.003）是中转开腹的独立危险因素。以上 4 种因素组合所建立回归方程预测中转开腹的 ROC 曲线下面积为 0.891，敏感度为 80.0%，特异度为 98.9%。与中转开腹患者比较，完成腹腔镜手术患者手术时间、术中出血量、术后镇痛剂使用次数、术后抗生素使用时间、术后肛门排气时间、住院时间、住院费用、并发症发生率均明显减少（均 P<0.05）。
结论：对于 LC+LCBDE 患者，应仔细评估上述 4 种独立危险因素，这对于完善术前准备、选择手术方式，降低开放手术转化率，以及改善患者预后具有重要意义。
Risk factors for open conversion in patients undergoing laparoscopic cholecystectomy combined with common bile duct exploration and relevant clinical analysis
CorrespondingAuthor:SHANG Zhonghua Email: shangzhonghua2001@163.com
Abstract
Objective: To determine the risk factors for conversion to open surgery in patients undergoing laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct exploration (LCBDE) in treatment of gallbladder stones with common bile duct stones and perform the relevant clinical analysis.
Methods: Th e clinical data of 197 patients undergoing LC plus LCBDE from January 2014 to June 2018 were retrospectively analyzed. The risk factors for conversion to open surgery were screened, and the perioperative variables and postoperative complications between patients undergoing completed laparoscopic surgery and those converted to open surgery were compared.
Results: Fifteen cases (7.6%) of the 197 patients were converted to open surgery. Univariate and multivariate analyses showed that serum total bilirubin>17.1 µmol/L (OR=5.156, P=0.032), gallbladder wall thickness >6 mm (OR=7.971, P=0.012), jaundice (OR=10.715, P=0.002) and stone incarceration in the lower part of the common bile duct (OR=20.203, P=0.003) were independent risk factors for open conversion. For predicting open conversion, the regression equation established by integration of the above 4 factors showed an area under ROC of 0.891, with a sensibility of 80.0% and specificity of 98.9%. In patients undergoing completed laparoscopic surgery compared with those undergoing open conversion, the operative time, intraoperative blood loss, number of postoperative analgesic use, time period of postoperative antibiotic use, time to first postoperative anal gas passage, length of hospital stay, hospitalization cost and incidence of complications were significantly reduced (all P<0.05).
Conclusion: For patients undergoing LC plus LCBDE, the above 4 independent risk factors should be carefully evaluated, which has important significance for optimal preoperative preparation, operative procedure selection, reducing open conversion rate and improvement of the patient outcomes.
Keywords：
Choledocholithiasis; Cholecystolithiasis; Laparoscopes; Conversion to Open Surgery; Risk Factors
Methods: Th e clinical data of 197 patients undergoing LC plus LCBDE from January 2014 to June 2018 were retrospectively analyzed. The risk factors for conversion to open surgery were screened, and the perioperative variables and postoperative complications between patients undergoing completed laparoscopic surgery and those converted to open surgery were compared.
Results: Fifteen cases (7.6%) of the 197 patients were converted to open surgery. Univariate and multivariate analyses showed that serum total bilirubin>17.1 µmol/L (OR=5.156, P=0.032), gallbladder wall thickness >6 mm (OR=7.971, P=0.012), jaundice (OR=10.715, P=0.002) and stone incarceration in the lower part of the common bile duct (OR=20.203, P=0.003) were independent risk factors for open conversion. For predicting open conversion, the regression equation established by integration of the above 4 factors showed an area under ROC of 0.891, with a sensibility of 80.0% and specificity of 98.9%. In patients undergoing completed laparoscopic surgery compared with those undergoing open conversion, the operative time, intraoperative blood loss, number of postoperative analgesic use, time period of postoperative antibiotic use, time to first postoperative anal gas passage, length of hospital stay, hospitalization cost and incidence of complications were significantly reduced (all P<0.05).
Conclusion: For patients undergoing LC plus LCBDE, the above 4 independent risk factors should be carefully evaluated, which has important significance for optimal preoperative preparation, operative procedure selection, reducing open conversion rate and improvement of the patient outcomes.