Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery Yong Loo Lin School of Medicine, National University Hospital, Singapore, 119074, Singapore.
Surg Endosc. 2009 Nov;23(11):2424-9. doi: 10.1007/s00464-009-0374-x. Epub 2009 Mar 5.
A higher rate of conversion to open surgery is a well-known problem in patients with acute cholecystitis undergoing laparoscopic cholecystectomy. The aim of this study is to analyze factors which may impact on conversion rates, and to analyze our outcomes following implementation of a departmental strategy in reducing conversion rates.
122 patients with acute cholecystitis were considered for laparoscopic cholecystectomy from July 2003 to July 2007. An audit of the results of laparoscopic cholecystectomy was done in July 2005 and a departmental strategy aimed at reducing the conversion rates was introduced. The strategies included early laparoscopic cholecystectomy (within 72 hours of admission), performed or supervised by specialist hepatobiliary surgeons, and modifications of operative techniques. This study compares the conversion rates before and after that audit. Forty-eight patients (group A) were from the preaudit period and the remaining 74 (group B) were from the postaudit period. A multivariate analysis was performed to identify risk factors for conversion to open surgery and whether the strategies implemented resulted in decrease in conversion rates.
In the group A patients, there was a conversion rate of 29.2%. Gallbladder wall thickness of greater than 5 mm was found to be a statistically significant (p = 0.028) risk factor for conversion to open surgery. In group B patients, the conversion rates were significantly lower at 6.75% (p = 0.001). Analyzing both groups of patients, using multivariate analysis, gallbladder wall thickness, increasing age, and preaudit operative period were found to be independently associated with conversion to open surgery.
This study demonstrated that, with specific strategies to decrease conversion and with technical improvements, the conversion rates can be decreased with no demonstrable difference in postoperative complications. Gallbladder wall thickness and increasing age are risk factors for conversion to open surgery.
在接受腹腔镜胆囊切除术的急性胆囊炎患者中，转为开腹手术的比率较高是一个众所周知的问题。本研究旨在分析可能影响转化率的因素，并分析我们在实施降低转化率的部门策略后的结果。
2003 年 7 月至 2007 年 7 月期间，考虑对 122 例急性胆囊炎患者进行腹腔镜胆囊切除术。2005 年 7 月对腹腔镜胆囊切除术的结果进行了审核，并引入了一项旨在降低转化率的部门策略。这些策略包括在入院后 72 小时内进行早期腹腔镜胆囊切除术（由肝胆外科专家进行或监督）以及修改手术技术。本研究比较了审核前后的转化率。48 例患者（A 组）来自审核前时期，其余 74 例患者（B 组）来自审核后时期。进行了多变量分析，以确定转为开腹手术的风险因素，以及实施的策略是否导致转化率降低。
在 A 组患者中，转化率为 29.2%。胆囊壁厚度大于 5 毫米被发现是转为开腹手术的统计学显著（p=0.028）风险因素。在 B 组患者中，转化率明显较低，为 6.75%（p=0.001）。对两组患者进行多变量分析，发现胆囊壁厚度、年龄增加和审核前手术期是与转为开腹手术独立相关的因素。
本研究表明，通过降低转化率的具体策略和技术改进，可以降低转化率，而术后并发症无明显差异。胆囊壁厚度和年龄增加是转为开腹手术的风险因素。
