Tayeb M, Raza S A, Khan M R, Azami R
Department of Surgery, Aga Khan University, Karachi, Pakistan.
J Postgrad Med. 2005 Jan-Mar;51(1):17-20; discussion 21-2.
Laparoscopic cholecystectomy has become the gold standard in the treatment of symptomatic cholelithiasis. Some patients require conversion to open surgery and several preoperative variables have been identified as risk factors that are helpful in predicting the probability of conversion. However, there is a need to devise a risk-scoring system based on the identified risk factors to (a) predict the risk of conversion preoperatively for selected patients, (b) prepare the patient psychologically, (c) arrange operating schedules accordingly, and (d) minimize the procedure-related cost and help overcome financial constraints, which is a significant problem in developing countries.
This study was aimed to evaluate preoperative risk factors for conversion from laparoscopic to open cholecystectomy in our setting.
A case control study of patients who underwent laparoscopic surgery from January 1997 to December 2001 was conducted at the Aga Khan University Hospital, Karachi, Pakistan.
All those patients who were converted to open surgery (n = 73) were enrolled as cases. Two controls who had successful laparoscopic surgery (n = 146) were matched with each case for operating surgeon and closest date of surgery.
Descriptive statistics were computed and, univariate and multivariate analysis was done through multiple logistic regression.
The final multivariate model identified two risk factors for conversion: ultrasonographic signs of inflammation (adjusted odds ratio [aOR] = 8.5; 95% confidence interval [CI]: 3.3, 21.9) and age > 60 years (aOR = 8.1; 95% CI: 2.9, 22.2) after adjusting for physical signs, alkaline phosphatase and BMI levels.
Preoperative risk factors evaluated by the present study confirm the likelihood of conversion. Recognition of these factors is important for understanding the characteristics of patients at a higher risk of conversion.
腹腔镜胆囊切除术已成为治疗有症状胆结石的金标准。一些患者需要转为开腹手术，并且已确定了几个术前变量作为有助于预测转为开腹手术概率的危险因素。然而，需要基于已确定的危险因素设计一个风险评分系统，以（a）术前预测特定患者转为开腹手术的风险，（b）让患者做好心理准备，（c）相应地安排手术日程，以及（d）将手术相关成本降至最低并有助于克服经济限制，这在发展中国家是一个重大问题。
本研究旨在评估我们所在环境中腹腔镜胆囊切除术转为开腹手术的术前危险因素。
在巴基斯坦卡拉奇的阿迦汗大学医院对1997年1月至2001年12月接受腹腔镜手术的患者进行了一项病例对照研究。
所有转为开腹手术的患者（n = 73）被纳入病例组。两名成功进行腹腔镜手术的对照患者（n = 146）与每个病例在手术医生和最近手术日期方面进行匹配。
计算描述性统计量，并通过多元逻辑回归进行单因素和多因素分析。
最终的多因素模型确定了两个转为开腹手术的危险因素：炎症的超声征象（校正比值比[aOR]=8.5；95%置信区间[CI]：3.3，21.9）和年龄>60岁（aOR = 8.1；95%CI：2.9，22.2），这是在对体征、碱性磷酸酶和体重指数水平进行校正之后得出的。
本研究评估的术前危险因素证实了转为开腹手术的可能性。识别这些因素对于了解转为开腹手术风险较高患者的特征很重要。
