Department of Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
Surg Endosc. 2010 Dec;24(12):3068-72. doi: 10.1007/s00464-010-1091-1. Epub 2010 May 7.
BACKGROUND: Conversion from laparoscopic to open cholecystectomy may not be desirable due to the increased complication rate and prolonged convalescence. In Denmark, nationwide data show that 7.7% of the laparoscopic cholecystectomies are converted to open surgery. This article aims to document the relationship of gender to conversion rate and length of hospital stay after laparoscopic cholecystectomy in a national cohort of patients. METHODS: The gender of 5,951 patients from the 2007 National Danish Cholecystectomy Database was compared with conversion rate, length of hospital stay, and various risk factors using multivariate analyses. RESULTS: The findings showed that 14.3% of the patients had acute cholecystitis and that men had the highest risk (odds ratio [OR], 1.94; 95% confidence interval [CI], 1.66-2.27). The operative findings for the men included sequelae from previous acute cholecystitis more frequently than the findings for the women (OR, 1.89; 95% CI, 1.67-2.15). The rate for conversion from laparoscopic to open surgery was 7.7%, and male sex was highly associated with conversion (OR, 2.48; 95% CI, 2.04-3.01). Thus, 259 (5.8%) of the 4,451 operations for women were converted to laparotomy compared with 199 (13.3%) of the 1,500 operations for men. No significant sex differences were found in the proportion of bile duct lesions (those requiring reconstructive surgery as well as those that could be handled by endoscopy or T-tube drainage, suturing, or both) or in the 30-day mortality rate. The multivariate analyses showed that male sex was a significant factor for conversion but not for length of postoperative stay or readmission. CONCLUSION: Men showed a significantly higher risk of the operation being converted from laparoscopic to open cholecystectomy than women (OR, 2.48; 95% CI, 2.04-3.01). The main reason for this may be that men more frequently had acute cholecystitis or sequelae from previous acute cholecystitis. These results can be used to give patients a better basis for their informed consent and better resource management in connection with the operation.
背景：由于并发症发生率增加和恢复期延长，将腹腔镜胆囊切除术转为开放性手术可能并不理想。在丹麦，全国范围内的数据显示，7.7%的腹腔镜胆囊切除术转为开放性手术。本文旨在记录性别与全国范围内患者队列中转开率和腹腔镜胆囊切除术后住院时间的关系。
方法：对 2007 年丹麦全国胆囊切除术数据库中的 5951 例患者的性别与转开率、住院时间和各种危险因素进行了比较，并采用多因素分析。
结果：研究结果显示，14.3%的患者患有急性胆囊炎，男性风险最高（优势比[OR]，1.94；95%置信区间[CI]，1.66-2.27）。男性的手术结果包括既往急性胆囊炎的后遗症比女性更常见（OR，1.89；95% CI，1.67-2.15）。腹腔镜转为开腹手术的比例为 7.7%，男性与转开术高度相关（OR，2.48；95% CI，2.04-3.01）。因此，4451 例女性手术中，有 259 例（5.8%）转为开腹手术，而 1500 例男性手术中，有 199 例（13.3%）转为开腹手术。在胆管损伤的比例（需要重建手术以及可以通过内镜或 T 管引流、缝合或两者处理的胆管损伤）或 30 天死亡率方面，没有发现显著的性别差异。多因素分析显示，男性是转开的显著因素，但不是术后住院时间或再入院的显著因素。
结论：与女性相比，男性腹腔镜胆囊切除术转为开腹手术的风险显著更高（OR，2.48；95% CI，2.04-3.01）。主要原因可能是男性更常患有急性胆囊炎或既往急性胆囊炎后遗症。这些结果可用于为患者提供更好的知情同意基础，并在手术方面更好地管理资源。
Surg Endosc. 2010-5-7
Langenbecks Arch Surg. 2019-7-11
World J Surg. 1997-6
Arq Bras Cir Dig. 2019-8-26
Int J Environ Res Public Health. 2022-12-27
Arq Bras Cir Dig. 2019-8-26
Indian J Surg. 2017-10
Int J Qual Health Care. 2009-6
Am J Surg. 2009-6
Surg Laparosc Endosc Percutan Tech. 2008-4
Cochrane Database Syst Rev. 2006-10-18
J Gastrointest Surg. 2006
Ugeskr Laeger. 2005-6-13
Zotero 插件