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中华普外科手术学杂志(电子版)

中华普外科手术学杂志(电子版) ›› 2020, Vol. 14 ›› Issue (05) : 512 -516. doi: 10.3877/cma.j.issn.1674-3946.2020.05.023

所属专题： 指南与规范； 文献； 指南共识；

论著

基于东京指南(2018)下中度(Ⅱ级)急性胆囊炎行腹腔镜胆囊切除中转开腹危险因素分析
刘林勋1,†(), 杨金煜1, 叶成杰1, 徐正光1, 马连1   
  1. 1. 810007　青海西宁，青海省人民医院普通外科
  • 收稿日期:2020-02-26 出版日期:2020-10-26
  • 通信作者: 刘林勋

Risk factors of conversion from laparoscopic cholecystectomy to open cholecystectomy for moderate (level Ⅱ) acute cholecystitis based on Tokyo guidelines (2018)

Linxun Liu1,†(), Jingyu Yang1, Chengjie Ye1, Zhengguang Xu1, Lian Ma1   

  1. 1. Department of General Surgery, Qinghai provice People’s Hospital, Xining, QingHai, 810007 China
  • Received:2020-02-26 Published:2020-10-26
  • Corresponding author: Linxun Liu
  • About author:
    Corresponding author: Liu Linxun, Email:
  • Supported by:
    Qinghai Basic Research Project(2018-ZJ-758)
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引用本文：

刘林勋, 杨金煜, 叶成杰, 徐正光, 马连. 基于东京指南(2018)下中度(Ⅱ级)急性胆囊炎行腹腔镜胆囊切除中转开腹危险因素分析[J/OL]. 中华普外科手术学杂志(电子版), 2020, 14(05): 512-516.

Linxun Liu, Jingyu Yang, Chengjie Ye, Zhengguang Xu, Lian Ma. Risk factors of conversion from laparoscopic cholecystectomy to open cholecystectomy for moderate (level Ⅱ) acute cholecystitis based on Tokyo guidelines (2018)[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2020, 14(05): 512-516.

目的

探讨中度(Ⅱ级)急性胆囊炎行腹腔镜胆囊切除(LC)中转开腹的危险因素。

方法

回顾性分析2014年1月至2016年1月137例急性胆囊炎患者资料，57例患者行LC，80例患者行LC中转开腹，依据手术方式不同分成LC组和中转开腹组。所有数据采用SPSS13.0统计软件进行处理。计量资料以(±s)表示，对各变量进行正态性检验，各变量未通过正态性检验(P<0.05)，以连续性变量以中位数(四分位间距)表示并做秩和检验。多因素分析采用Logistic回归分析，P<0.05为差异有统计学意义。

结果

(1)单因素分析结果显示：患者年龄、急性胆囊炎发生次数、患者本次发病最高白细胞计数、患者最高体温、彩超诊断下胆囊厚度、胆囊大小中转开腹组均显著高于LC组(P<0.05)，LC医师年资中转开腹组均显著低于LC组(P<0.05)。(2)多因素分析结果显示：急性胆囊炎发生次数，患者本次发病最高体温是中转开腹的独立危险因素，LC医师年资是中转开腹的独立保护因素。

结论

急性胆囊炎发生次数、患者体温是中度(Ⅱ级)急性胆囊炎行LC中转开腹独立危险因素，有经验的手术医师可以减少该类疾病中转开腹的概率。

关键词: 胆囊炎，急性, 胆囊切除术，腹腔镜, 剖腹术, 危险因素, 东京指南(2018), 中度(Ⅱ级)
Objective

To investigate the risk factors of conversion from laparoscopic cholecystectomy(LC) to open cholecystectomy(OC) for moderate (level Ⅱ) acute cholecystitis based on Tokyo guidelines (2018).

Methods

The data of 137 patients with acute cholecystitis from January 2014 to January 2016 were retrospectively analyzed. LC was performed in 57 patients, and conversion from LC to OC was performed in 80 patient, which were divided into LC group and Conversion group. Data were processed by SPSS13.0 statistical software. Measuring data were expressed as (mean±SD) and tested for the normality of variables. Variables did not pass the normality test were expressed as median (quartile spacing) and rank sum test was performed. Logistic regression analysis was used for multivariate analysis, (P<0.05) was statistically significant and the independent risk factors affecting conversion were determined.

Results

(1) The risk factors of conversion to OC for moderate (level Ⅱ) acute cholecystitis were analyzed by single factor analysis. The results showed that age, frequency of seizures, white blood cell count, patient’s highest body temperature, gallbladder thickness and gallbladder size in the Conversion group were significantly higher than those in the LC group (P<0.05). The seniority of surgeon in the Conversion group was significantly lower than that in the LC group (P<0.05). Multivariate analysis showed that the frequency of seizures and the highest body temperature of patients were independent risk factors for conversion to OC, and the seniority of surgeon was an independent protective factor for conversion to OC.

Conclusion

The frequency of seizures and the highest body temperature of patients are independent risk factors for conversion to OC for moderate (level Ⅱ) acute cholecystitis. Experienced surgeons can reduce the probability of conversion to OC in such diseases.

Key words: Cholecystitis, acute, Cholecystectomy, laparoscopic, Laparotomy, Risk factors, Tokyo guidelines(2018), Moderate(grade Ⅱ)
表1 80例行LC中转开腹患者的各因素做正态检验结果分析
变量 检验方法 统计值 P
年龄 Shapiro-Wilk 0.915 0.000
急性胆囊炎发生次数 Shapiro-Wilk 0.897 0.000
LC医师年资 Shapiro-Wilk 0.680 0.000
白细胞计数 Shapiro-Wilk 0.066 0.000
最高体温 Shapiro-Wilk 0.914 0.000
胆囊厚度 Shapiro-Wilk 0.873 0.000
胆囊大小 Shapiro-Wilk 0.869 0.000
表2 80例行LC中转开腹患者的单因素分析[例(%)]
变量 对照(n＝57) 中转开腹(n＝80) χ2/Z P
性别 37(64.91) 59(73.75) 1.240 0.266
年龄 46.00(19.00) 63.5(9.00) -6.420 0.000
急性胆囊发生次数 2.00(2.00) 3.00(1.50) -4.488 0.000
LC医师年资 9.00(31.00) 4.00(10.25) 3.219 0.001
白细胞计数 6.52(3.15) 11.17(6.16) -7.483 0.000
最高体温 36.40(0.50) 38.50(1.15) -8.534 0.000
胆囊厚度 3.00(2.00) 7.00(5.00) -7.455 0.000
胆囊大小 2400.00(0.00) 4500.00(1364.00) -8.706 0.000
表3 80例行LC中转开腹患者的多因素Logistics回归结果
变量 回归系数 标准误差 Wald χ2 P
常数项 -105.621 28.865 13.389 0.000
性别(男∶女) 1.692 1.398 1.464 0.226
年龄 0.067 0.042 2.566 0.109
急性胆囊炎发生次数 0.959 0.489 3.850 0.050
LC医师年资 -0.074 0.037 3.966 0.046
白细胞计数 -0.001 0.005 0.016 0.901
最高体温 1.872 0.605 9.579 0.002
胆囊厚度 0.110 0.229 0.232 0.630
胆囊大小 -0.005 0.003 2.544 0.111
变量 OR(95%CI)
性别(男∶女) 5.429(0.351-84.080)
年龄 1.069(0.985-1.160)
急性胆囊炎发生次数 2.608(1.001-6.790)
LC医师年资 0.928(0.863-1.000)
白细胞计数 0.999(0.989-1.010)
最高体温 6.504(1.987-21.290)
胆囊厚度 1.117(0.712-1.750)
胆囊大小 0.995(0.990-1.000)
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