探讨急性胆囊炎LC术中转开腹的危险因素及预后情况。

回顾性分析2014年3月至2017年7月231例急性胆囊炎行LC术的患者的临床资料，根据患者LC术中是否转开腹，分为LC术组(205例)和转开腹组(26例)对比分析两组患者性别、年龄、BMI指数、病程、胆囊壁厚及生化检查等情况，本研究采用Stata 14.1统计软件对数据处理。计量资料单因素分析采用t检验，计数资料单因素分析采用卡方检验。采用Logistic回归模型分析LC术中转开腹危险因素，并拟合ROC曲线评价模型价值，P<0.05为差异具有统计学意义。

单因素分析显示，BMI指数、病程、胆囊壁厚度、白细胞计数、碱性磷酸酶5个因素与LC术中转开腹有关；多因素Logistic回归分析显示，BMI指数(OR＝1.407, P＝0.000)、白细胞计数(OR＝1.600, P＝0.003)、碱性磷酸酶(OR＝1.042, P＝0.000)是LC术中转开腹的独立危险因素。26例转开腹患者术后观察无严重的并发症发生。

手术医师在LC术前应对患者体质状况，白细胞水平、碱性磷酸酶等情况进行合理的评估，以降低LC术中转开腹率。

To investigate the risk factors and prognosis of conversion to open laparotomy of laparoseopic cholecystectomy for acute cholecystitis.

The clinical data of 231 patients from March 2014 to July 2017 who were diagnosed as acute cholecystitis and treated with LC were collected and analyzed. According to whether conversion to open laparotomy, the patients were divided into LC group (205 cases) and open laparotomy group (26 cases). The clinical data were analyzed and compared with Stata 14.1 statistical software. T test was used for the analysis of quantitative data. Counting data single factor analysis was adopted by chi-square test. The Logistic regression model was used to analyze the risk factors of LC transshipment, and the ROC curve was fitted. In this study, P<0.05 was considered to be statistically significant.

Single factor analysis showed that BMI, duration, thickness of gallbladder wall and white blood cell count were associated with conversion to open laparotomy of LC. Multifactorial Logistic regression analysis showed that: BMI (OR=1.407, P=0.000), white blood cell count (OR=1.600, P=0.003), alkaline phosphatase (OR=1.042, P=0.000) were the independent risk factors; No serious complications were observed in the open laparotomy group.

The operation physician should evaluate the physical condition, white blood cell level, alkaline phosphatase and other conditions of the patients before LC operation, so as to reduce the rate of conversion to open laparotomy.