Rosen Michael, Brody Fred, Ponsky Jeffrey
Department of General Surgery and Minimally Invasive Surgery Center, Cleveland Clinic Foundation, 9500 Euclid Ave., A-80, Cleveland, OH 44195, USA.
Am J Surg. 2002 Sep;184(3):254-8. doi: 10.1016/s0002-9610(02)00934-0.
Laparoscopic cholecystectomy has replaced open cholecystectomy for the treatment of gallbladder disease. However, certain cases still require conversion to open procedures. Identifying these patients at risk for conversion remains difficult. This study identifies risk factors that may predict conversion from a laparoscopic to an open procedure.
From January 1996 to January 2000, a total of 1,347 laparoscopic cholecystectomies were performed at the Cleveland Clinic Foundation (CCF). A retrospective analysis of 34 parameters including patient demographics, clinical history, laboratory data, ultrasound results, and intraoperative details was performed. Stepwise, multivariate logistic regression was used to determine those variables predicting conversion of laparoscopic cholecystectomy.
Seventy-one (5.3%) laparoscopic cholecystectomies required conversion. Multivariate analysis revealed that for all cases, a white blood cell count >9 (2.9 greater odds ratio [OR] of conversion P = 0.006) and a gallbladder wall thickness >0.4 cm (7.2 OR, P <0.001) predicted conversion to open cholecystectomy. However, when patients with acute cholecystitis were evaluated only a body mass index >30 kg/m(2) (5.6 OR, P = 0.02) predicted conversion. For patients undergoing elective cholecystectomy, a body mass index >40 kg/m(2) (33.1 OR, P = 0.01) and a wall thickness >0.4 cm (24.7 OR, P <0.004) predicted conversion. Finally, an ASA >2 (5.3 OR, P = 0.01) predicted conversion in patients undergoing nonelective cholecystectomies.
Obese patients with acute cholecystitis undergoing laparoscopic cholecystectomy have an increased chance of conversion. Likewise, patients with multiple comorbid diseases undergoing nonelective laparoscopic cholecystectomy are more likely to require conversion. Finally, in an elective laparoscopic cholecystectomy, morbidly obese patients with chronic cholecystitis and a thickened gallbladder wall are more likely to require conversion. These factors can help counsel patients undergoing laparoscopic cholecystectomy with regards to the probability of conversion to an open procedure.
腹腔镜胆囊切除术已取代开腹胆囊切除术用于治疗胆囊疾病。然而，某些病例仍需要转为开腹手术。识别这些有转为开腹手术风险的患者仍然困难。本研究确定了可能预测从腹腔镜手术转为开腹手术的危险因素。
1996年1月至2000年1月，克利夫兰诊所基金会（CCF）共进行了1347例腹腔镜胆囊切除术。对包括患者人口统计学、临床病史、实验室数据、超声结果和术中细节在内的34项参数进行了回顾性分析。采用逐步多因素逻辑回归分析来确定那些预测腹腔镜胆囊切除术转为开腹手术的变量。
71例（5.3%）腹腔镜胆囊切除术需要转为开腹手术。多因素分析显示，对于所有病例，白细胞计数>9（转为开腹手术的优势比[OR]高2.9，P = 0.006）和胆囊壁厚度>0.4 cm（OR为7.2，P <0.001）预测会转为开腹胆囊切除术。然而，仅评估急性胆囊炎患者时，体重指数>30 kg/m²（OR为5.6，P = 0.02）预测会转为开腹手术。对于接受择期胆囊切除术的患者，体重指数>40 kg/m²（OR为33.1，P = 0.01）和胆囊壁厚度>0.4 cm（OR为24.7，P <0.004）预测会转为开腹手术。最后，美国麻醉医师协会（ASA）分级>2（OR为5.3，P = 0.01）预测非择期胆囊切除术患者会转为开腹手术。
接受腹腔镜胆囊切除术的急性胆囊炎肥胖患者转为开腹手术的几率增加。同样，接受非择期腹腔镜胆囊切除术的患有多种合并症的患者更有可能需要转为开腹手术。最后，在择期腹腔镜胆囊切除术中，患有慢性胆囊炎且胆囊壁增厚的病态肥胖患者更有可能需要转为开腹手术。这些因素有助于就转为开腹手术的可能性向接受腹腔镜胆囊切除术的患者提供咨询。
