Simopoulos Constantinos, Botaitis Sotirios, Karayiannakis Anastasios J, Tripsianis Grigorios, Pitiakoudis Michail, Polychronidis Alexandros
Second Department of Surgery, Democritus University of Thrace, Alexandroupolis, Greece.
Am Surg. 2007 Apr;73(4):371-6.
The aim of this study was to evaluate the impact of acute cholecystitis (AC), obesity, and previous abdominal surgery on laparoscopic cholecystectomy (LC) outcomes. Records of 1940 patients undergoing LC in 1992 and 2004 were reviewed in order to assess the independent and joint effects of the above risk factors on conversion, morbidity, operation time, and hospital stay. In multivariate regression analysis, adjusting for sex and age, AC alone and in combination with obesity or previous abdominal surgery increased the risk of conversion and complications and was associated with prolonged operation time and hospital stay compared with the patients without any of the risk factors (reference group). The independent and joint effects of obesity and previous abdominal surgery were significant only on operation time. On the contrary, previous upper abdominal surgery alone and in combination with AC was associated with 3- and 17-fold relative odds of conversion, respectively. The combined presence of AC, obesity, and previous abdominal surgery yielded an odds ratio for conversion of 7.5 and for complications of 10.7, as well as a longer operation time and hospital stay. The presence of previous upper abdominal surgery with AC and obesity had a substantial effect on conversion, with an odds ratio of 87.1 compared with the reference group. LC is safe in patients with AC, previous abdominal surgery, or obesity. However, the presence of inflammation alone or in combination with obesity and/or previous (especially upper) abdominal surgery is the main factor that influences the adverse outcomes of LC.
本研究旨在评估急性胆囊炎（AC）、肥胖及既往腹部手术对腹腔镜胆囊切除术（LC）预后的影响。回顾了1992年和2004年接受LC的1940例患者的记录，以评估上述危险因素对中转开腹、发病率、手术时间及住院时间的独立及联合影响。在多因素回归分析中，校正性别和年龄后，单独的AC以及AC合并肥胖或既往腹部手术与无任何危险因素的患者（参照组）相比，增加了中转开腹和并发症的风险，并与手术时间延长和住院时间延长相关。肥胖和既往腹部手术的独立及联合影响仅对手术时间有显著意义。相反，单独的既往上腹部手术以及既往上腹部手术合并AC分别使中转开腹的相对比值比增加3倍和17倍。AC、肥胖和既往腹部手术同时存在时，中转开腹的比值比为7.5，并发症的比值比为10.7，同时手术时间和住院时间更长。既往上腹部手术合并AC和肥胖对中转开腹有实质性影响，与参照组相比，比值比为87.1。LC对于患有AC、既往腹部手术或肥胖的患者是安全的。然而，单独的炎症或炎症合并肥胖和/或既往（尤其是上腹部）腹部手术是影响LC不良预后的主要因素。
