腹腔镜胆囊切除术中转开腹危险因素的探讨-外科学专业论文.docxVIP

— — PAGE 1— 摘 要 腹腔镜胆囊切除术中转开腹危险因素的探讨 研究生：文飞 导师：段永亮副教授 摘 要 目的：探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy LC）中转开腹的危 险因素。方法： 回顾性分析2006年3月至2008年6月收治的1628例LC的临床资料,用χ2 检验进行单因素分析，再进行logistic多元回归分析，筛选影响LC转开腹手术的独立 的危险因素。结果：本组1628例病人中1586例LC成功，42例中转开腹（2.58%）。单 因素χ2分析结果显示LC失败的危险因素有男性、高龄（＞65岁）、肝硬化、胆囊壁 增厚（＞4cm）、急性胆囊炎发作时间（＞72h）、上腹部手术史、白细胞增高、胆囊 颈部结石嵌顿、胰腺炎病史、糖尿病为中转开腹的主要危险因素(P＜0.05)。多因素 logistic回归分析显示男性、肝硬化、胆囊壁增厚（＞4cm）、白细胞增高、急性胆囊 炎发作时间（＞72h）、上腹部手术史、胆囊颈部结石嵌顿、胰腺炎病史、糖尿病是 影响腹腔镜中转开腹率的独立危险因素（OR＞1）。结论：从男性、肝硬化、胆囊壁 增厚（＞4cm）、白细胞增高、急性胆囊炎发作时间（＞72h）、上腹部手术史、胆囊 颈部结石嵌顿、胰腺炎病史、糖尿病9种危险因素,可以预测中转的概率。术前对病人 进行全面的评估，正确掌握中转开腹的时机是降低LC手术严重并发症发生的有效措 施。 关键词：胆囊切除术；腹腔镜；中转开腹手术；危险因素 新疆医科大学医学硕士学位论文 The risk factors of laparoscopic cholecystectomy conversion to open cholecystectomy. Postgraduate: Wen Fei Supervisor: Vice Prof Duan Yong Liang. Abstract Objective: To study the risk factors on laparoscopic cholecystectomy (LC) conversion to open cholecystectomy (OC). Methods: Clinical data of 1628 patients undergoing LC from Mar. 2006 to Jun. 2008 were collected and analyzed retrospectively. Single factor analysis was performed by χ2. Multiple factor analysis with logistic regression was performed for the risk factors. The independent risk factors that affect the conversion rate were selected. Results: It was found that among the 1628 cases of cholecystitis, 1586 underwent laparoscopic cholecystectomy successfully and 42(2.58%) had conversion to open cholecystectomy. Univariate analysis by χ2 showed that male gender, Age ＞ 65, cirrhosis, thickened gallbladder wall( ＞ 4cm), Duration of acute cholecystectomy more than 72h, previous upper abdom operation history, high lever of leukocyte count, stone incarceration in cholecystic neck, pancreatitis case history and diabetes mellitus were significantly correlated with the rate of conversion to open procedure(P ＜ 0.05). Multivariate analysis with logistic revealed that male gender, cirrhosis, thickened gallbladder wall(＞4cm), Duration of acute cholecyste