Sokol Andrew I, Chuang Kenneth, Milad Magdy P
Cleveland Clinic Foundation, Cleveland, Ohio, USA.
J Am Assoc Gynecol Laparosc. 2003 Nov;10(4):469-73. doi: 10.1016/s1074-3804(05)60146-6.
To identify risk factors and short-term outcomes associated with conversion from laparoscopic surgery to laparotomy.
Case control study (Canadian Task Force classification II-2).
Large urban, academic medical center.
All 2530 gynecologic laparoscopies, including those converted to laparotomy.
Laparoscopic surgery.
Statistical analysis was performed to compare risk factors in converted versus non-converted cases. Multiple logistic regression analysis was performed using variables found to be significant on univariate analysis. Of 2530 laparoscopies identified, 159 (6.3%) were converted to laparotomy; 323 were selected by random number assignment from the remaining cases for the control group. The following factors were significantly associated with unintended laparotomy (OR; 95% CI): surgeon inexperience (2.43; 1.38, 4.17), level of laparoscopic complexity (3.19; 1.20, 5.10), body mass index greater than 30 kg/m(2) (2.45; 1.40, 4.41), suspicion of malignancy (17.45; 7.32, 43.57), history of laparotomy (1.34; 1.02, 1.78), presence of adhesions (2.30; 1.37, 3.76), and intraoperative technical difficulty (17.86; 7.32, 43.57). When stratified by level of complexity, experience in laparoscopy does not appear to confer protection during level 1 laparoscopic procedures (0.42; 0.12, 1.37) but does significantly reduce the frequency of conversion during level 2 procedures (0.39; 0.72, 0.93). Age, parity, bowel injury, vascular injury, and history of pelvic inflammatory disease and endometriosis did not increase the risk of conversion. Compared with controls, patients who were converted experienced significantly greater blood loss (p < 0.001), longer operating room time (p < 0.001), and longer hospital stay (p < 0.001).
All women undergoing laparoscopy should be counseled that unintended laparotomy is a known risk and has additional morbidity over laparoscopy alone. Less-experienced surgeons attempting complicated procedures significantly increase the risk of conversion.
确定与腹腔镜手术转为开腹手术相关的危险因素和短期结局。
病例对照研究（加拿大工作组分类II-2）。
大型城市学术医疗中心。
所有2530例妇科腹腔镜手术，包括转为开腹手术的病例。
腹腔镜手术。
进行统计分析以比较转为开腹手术与未转为开腹手术病例的危险因素。使用单因素分析中发现有显著意义的变量进行多因素逻辑回归分析。在确定的2530例腹腔镜手术中，159例（6.3%）转为开腹手术；从其余病例中通过随机数字分配选取323例作为对照组。以下因素与意外开腹显著相关（比值比；95%可信区间）：外科医生经验不足（2.43；1.38，4.17）、腹腔镜手术复杂程度（3.19；1.20，5.10）、体重指数大于30kg/m²（2.45；1.40，4.41）、怀疑恶性肿瘤（17.45；7.32，43.57）、开腹手术史（1.34；1.02，1.78）、存在粘连（2.30；1.37，3.76）以及术中技术困难（17.86；7.32，43.57）。按复杂程度分层时，腹腔镜经验在1级腹腔镜手术中似乎不能提供保护作用（0.42；0.12，1.37），但在2级手术中确实能显著降低转为开腹手术的频率（0.39；0.72，0.93）。年龄、产次、肠损伤、血管损伤以及盆腔炎和子宫内膜异位症病史并未增加转为开腹手术的风险。与对照组相比，转为开腹手术的患者失血明显更多（p<0.001）、手术时间更长（p<0.001）且住院时间更长（p<0.001）。
应告知所有接受腹腔镜手术的女性，意外开腹是一种已知风险，且比单纯腹腔镜手术有更多的发病情况。经验不足的外科医生尝试复杂手术会显著增加转为开腹手术的风险。
