【摘要】：目的:分析腹腔鏡膽囊切除術(shù)(Laparoscopic cholecystectomy LC)可能導(dǎo)致中轉(zhuǎn)開(kāi)腹的若干危險(xiǎn)因素,指導(dǎo)術(shù)前準(zhǔn)備及術(shù)中備案,進(jìn)一步減低開(kāi)腹率。方法:通過(guò)收集2010年-2016年我院733例腹腔鏡膽囊切除病人相關(guān)臨床數(shù)據(jù),回顧性對(duì)比分析可能導(dǎo)致術(shù)中中轉(zhuǎn)開(kāi)腹的相關(guān)危險(xiǎn)因素。結(jié)果:我院733例膽囊切除病人中成功行腹腔鏡膽囊切除病人704例(96%),29例中轉(zhuǎn)開(kāi)腹(4%)。中轉(zhuǎn)開(kāi)腹組中病理證實(shí)急性膽囊炎21例,占比72.4%。慢性膽囊炎5例,占比17.3%。急性化膿化膿壞疽性膽囊炎3例,占比10.3%。中轉(zhuǎn)開(kāi)腹原因中因急性期組織水腫嚴(yán)重,組織分離困難13例,占比43.3%。膽囊頸部多發(fā)結(jié)石至膽囊三角分離困難3例,占比10%。因膽囊炎反復(fù)發(fā)作致膽囊三角粘連致密分離困難6例,占比20%。上腹部腹腔廣泛粘連6例,占比20%。內(nèi)臟轉(zhuǎn)位1例,占比3.3%。在中轉(zhuǎn)開(kāi)腹組單因素卡方檢驗(yàn)中男性、白細(xì)胞升高、厚壁膽囊(4mm)、膽囊頸部結(jié)石、膽囊急性發(fā)作(72h)、谷丙轉(zhuǎn)氨酶升高、總膽紅素升高、糖尿病、上腹部手術(shù)病史等因素具有統(tǒng)計(jì)學(xué)差異(P0.05)。年齡、術(shù)前白蛋白水平、AST、膽囊結(jié)石大小未見(jiàn)明顯統(tǒng)計(jì)學(xué)差異(P0.05).在多因素回歸分析中發(fā)現(xiàn)膽囊頸部結(jié)石、膽囊急性發(fā)作(72h)、膽囊壁增厚(4mm)、總膽紅素升高、糖尿病5種危險(xiǎn)因素是腹腔鏡膽囊切除的獨(dú)立危險(xiǎn)因素(OR1)。結(jié)論:導(dǎo)致腹腔鏡膽囊切除中轉(zhuǎn)開(kāi)腹的危險(xiǎn)因素包括:膽囊壁增厚、總膽紅素升高、膽囊炎急性期(72h)、膽囊頸部結(jié)石、糖尿病5種。臨床醫(yī)師術(shù)前應(yīng)仔細(xì)評(píng)估上述危險(xiǎn)因素,進(jìn)一步降低中轉(zhuǎn)開(kāi)腹率,減少術(shù)后并發(fā)癥的出現(xiàn)。
[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.
【學(xué)位授予單位】：廣州醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R657.4

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