Analysis of the risk factors and prognosis of conversion to open laparotomy of laparoseopic cholecystectomy for acute cholecystitis

doi:10.3877/cma.j.issn.1674-3946.2018.04.019

Abstract

Abstract:

Objective

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

Methods

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.

Results

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.

Conclusion

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.

Key words: Cholecystitis, Acute, Laparotomy, Risk Factors

Wen shan Chen, Tiantian Wei. Analysis of the risk factors and prognosis of conversion to open laparotomy of laparoseopic cholecystectomy for acute cholecystitis[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2018, 12(04): 330-332.

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Figures/Tables 3

References 13

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因素		转开腹组(26例)	LC术组(205例)	χ²/t值	P值
性别		?	?	?	?
?	男	10	87	0.150	0.699
?	女	16	118	0.150	0.699
年龄(岁)		58.8±4.1	56.9±6.8	1.455	0.147
BMI指数		26.3±3.4	23.3±3.5	4.110	0.001
病程		?	?	?	?
?	≤3 d	16	164	4.571	0.033
?	>3 d	10	41	4.571	0.033
合并糖尿病		?	?	?	?
?	有	5	34	0.115	0.734
?	无	21	171	0.115	0.734
腹部手术史		?	?	?	?
?	有	4	20	0.785	0.376
?	无	22	185	0.785	0.376
胆囊壁厚		0.5±0.1	0.4±0.1	2.530	0.012
白细胞计数		16.6±2.2	14.4±2.0	5.213	0.000
白蛋白		35.3±3.5	33.7±3.6	1.960	0.051
碱性磷酸酶		201.8±35.6	163.2±33.0	5.577	0.000
谷丙转氨酶		30.0±9.9	32.9±9.6	－1.464	0.145
谷草转氨酶		19.5±7.0	22.1±6.8	－1.865	0.064

因素		转开腹组(26例)	LC术组(205例)	χ²/t值	P值
性别		?	?	?	?
?	男	10	87	0.150	0.699
?	女	16	118	0.150	0.699
年龄(岁)		58.8±4.1	56.9±6.8	1.455	0.147
BMI指数		26.3±3.4	23.3±3.5	4.110	0.001
病程		?	?	?	?
?	≤3 d	16	164	4.571	0.033
?	>3 d	10	41	4.571	0.033
合并糖尿病		?	?	?	?
?	有	5	34	0.115	0.734
?	无	21	171	0.115	0.734
腹部手术史		?	?	?	?
?	有	4	20	0.785	0.376
?	无	22	185	0.785	0.376
胆囊壁厚		0.5±0.1	0.4±0.1	2.530	0.012
白细胞计数		16.6±2.2	14.4±2.0	5.213	0.000
白蛋白		35.3±3.5	33.7±3.6	1.960	0.051
碱性磷酸酶		201.8±35.6	163.2±33.0	5.577	0.000
谷丙转氨酶		30.0±9.9	32.9±9.6	－1.464	0.145
谷草转氨酶		19.5±7.0	22.1±6.8	－1.865	0.064

组别	OR值	标准误	z	P>\|z\|	95%CI
组别	OR值	标准误	z	P>\|z\|	下限	上限
BMI指数	1.407	0.128	3.74	0.000	1.177	1.683
病程	1.377	0.751	0.59	0.558	0.472	4.012
胆囊壁厚	4.172	10.85	0.55	0.583	0.026	682.389
白细胞计数	1.600	0.253	2.98	0.003	1.174	2.180
碱性磷酸酶	1.042	0.010	4.26	0.000	1.022	1.062

组别	OR值	标准误	z	P>\|z\|	95%CI
组别	OR值	标准误	z	P>\|z\|	下限	上限
BMI指数	1.407	0.128	3.74	0.000	1.177	1.683
病程	1.377	0.751	0.59	0.558	0.472	4.012
胆囊壁厚	4.172	10.85	0.55	0.583	0.026	682.389
白细胞计数	1.600	0.253	2.98	0.003	1.174	2.180
碱性磷酸酶	1.042	0.010	4.26	0.000	1.022	1.062

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