单孔腹腔镜胆囊切除术中转开腹或传统腹腔镜手术的影响因素

Influencing factors of conversion to laparotomy or traditional laparoscopy in single-incision laparoscopic cholecystectomy

张鑫 ¹石明炜 ¹罗银义 ¹徐辉 ¹闫军²

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作者信息

1. 山西医科大学第一临床医学院,山西太原,030000
2. 山西医科大学第一医院肝胆胰外科
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摘要

目的:探讨单孔腹腔镜胆囊切除术(SILC)中转手术的影响因素.方法:回顾分析2011 年1 月至2021 年12 月为916 例患者行SILC的临床资料,其中883 例成功完成SILC,33 例中转手术,分析中转原因并对相应指标进行单因素、多因素Logistic分析.结果:33 例中转患者中18 例中转传统腹腔镜胆囊切除术(胆管变异7 例、胆囊动脉变异2 例、腹腔粘连3 例、胆囊体积大3 例、胆囊壁厚2 例、肥胖1 例),15 例中转开腹(胆管变异7 例、腹腔粘连8 例).单因素分析结果显示,BMI、腹部手术史、腹腔粘连、胆囊长径>8 cm、胆囊壁厚度>3mm、解剖变异是中转手术的影响因素(P<0.05);多因素Logistic分析结果显示,解剖变异(OR=8.103,95%CI=2.967～22.128,P<0.001)、BMI(OR=1.656,95%CI=1.391～1.971,P<0.001)、腹腔粘连(OR=3.782,95%CI=1.111～12.876,P=0.033)、胆囊长径>8 cm(OR=3.275,95%CI=1.266～8.467,P=0.014)、胆囊壁厚度>3 mm(OR=3.520,95%CI=1.321～9.384,P=0.012)是SILC中转的独立危险因素(P<0.05),而腹部手术史(OR=1.733,95%CI=0.565～5.317,P=0.336)不是独立危险因素(P>0.05).结论:BMI、解剖变异、胆囊长径>8cm、胆囊壁厚度>3mm、腹腔粘连是SILC中转的独立危险因素,术前应充分评估患者情况,选择合理的手术方案,预估术中风险.

Abstract

Objective:To investigate the influencing factors of conversion to laparotomy or traditional laparoscopy in single-inci-sion laparoscopic cholecystectomy(SILC).Methods:The clinical data of 916 patients who underwent SILC from Jan.2011 to Dec.2021 were retrospectively analyzed.883 cases of SILC were successful,33 cases were converted.Reasons for conversion were analyzed and univariate and multivariate logistic analysis was performed on the corresponding indicators.Results:Among 33 converted patients,18 patients underwent laparoscopic cholecystectomy(due to bile duct variation in 7 cases,cystic artery variation in 2 cases,abdominal adhesion in 3 cases,large volume of gallbladder in 3 cases,thick gallbladder wall in 2 cases,and obesity in 1 case),and 15 patients underwent laparotomy(due to bile duct variation in 7 cases and abdominal adhesion in 8 cases).Univariate analysis showed that there were statistically significant differences in BMI,abdominal operation history,abdominal adhesion,gallbladder length>8 cm,gallbladder wall thickness>3 mm and anatomical variation(P<0.05).Multivariate logistic analysis showed that anatomic variation(OR=8.103,95%CI=2.967～22.128,P<0.001),BMI(OR=1.656,95%CI=1.391～1.971,P<0.001),abdominal adhesion(OR=3.782,95%CI=1.111～12.876,P=0.033),length of gallbladder>8 cm(OR=3.275,95%CI=1.266～8.467,P=0.014),thickness of gallbladder wall>3 mm(OR=3.520,95%CI=1.321～9.384,P=0.012)were independent risk factors for conversion of SILC(P<0.05),history of abdominal surgery(OR=1.733,95%CI=0.565～5.317,P=0.336)was not an independent risk factor(P>0.05).Conclusions:BMI,anatomical variation,gallbladder length>8 cm,gallbladder wall thickness>3 mm and abdominal adhesion are independent risk factors for SILC conversion.Preoperative assessment of patients'conditions should be made to select reasonable surgical programs and estimate intraoperative risks.

关键词

胆囊切除术,腹腔镜/单孔/中转开腹手术/中转传统腹腔镜手术/影响因素分析

Key words

Cholecystectomy,laparoscopic/Single incision/Conversion to open surgery/Conversion to traditional laparoscopic surgery/Root cause analysis

引用本文复制引用

出版年

2024

腹腔镜外科杂志

山东大学

腹腔镜外科杂志

CSTPCD

影响因子：0.861

ISSN：1009-6612

参考文献量22

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