Department of General, Visceral and Transplant Surgery, University Hospital Tuebingen, Tuebingen, Germany.
Eur J Gastroenterol Hepatol. 2012 Sep;24(9):1033-8. doi: 10.1097/MEG.0b013e328354ad6e.
Laparoscopic cholecystectomy (LC) remains one of the most frequent surgical therapies for symptomatic gallstone disorders. Prolonged operative time is frequently associated with increased complication rates. The aim of this study was to identify the risk factors for prolonged operative times to minimize perioperative morbidity and optimize clinical management.
A total of 677 consecutive patients underwent LC. The exclusion criteria were conversion to an open procedure, intraoperative cholangiography, and liver cirrhosis (n=81). Data were analyzed retrospectively with respect to age, sex, BMI, ASA score, previous abdominal surgery, preoperative endoscopic retrograde cholangiopancreatography, acute cholecystitis, and surgeon's experience. Univariate and multivariate analyses were performed.
A total of 596 patients, mean (± SD) age of 52.2 ± 16.7 years, were analyzed. In all, 29% of the patients were obese (BMI ≥ 30 kg/m); 11% had ASA III. Five percent of patients had undergone previous upper abdominal surgery. Overall, 105/596 patients had an acute cholecystitis. Residents of general surgery performed 58% of all operations. The median operative time was 80 min (range, 15-281 min). No statistical significance was found between intraoperative and postoperative complications by surgeon's experience. Statistically, independent preoperative predictors for prolonged operative time as identified through multivariate analysis were acute cholecystitis, obesity, previous upper abdominal surgery, male sex, and low degree of surgical expertise.
The risk for prolonged operative times in LC can be assessed on the basis of patients' characteristics. Assessment of these factors not only helps to optimize the individual outcome for each patient but also improves the decision process toward operative training for junior surgeons.
腹腔镜胆囊切除术（LC）仍然是治疗有症状的胆囊结石疾病最常见的外科治疗方法之一。手术时间延长通常与并发症发生率增加有关。本研究旨在确定手术时间延长的危险因素，以最大限度地降低围手术期发病率并优化临床管理。
对 677 例连续接受 LC 的患者进行了回顾性研究。排除标准为转为开腹手术、术中胆管造影和肝硬化（n=81）。对年龄、性别、BMI、ASA 评分、既往腹部手术、术前内镜逆行胰胆管造影、急性胆囊炎和外科医生经验等数据进行了回顾性分析。进行了单因素和多因素分析。
共分析了 596 例患者，平均（±SD）年龄为 52.2±16.7 岁。其中，29%的患者肥胖（BMI≥30kg/m）；11%的患者 ASA 分级为 III 级。5%的患者有过上腹部手术史。总体而言，596 例患者中有 105 例患有急性胆囊炎。普外科住院医师完成了 58%的手术。中位手术时间为 80 分钟（范围为 15-281 分钟）。外科医生的经验并未发现手术中或手术后并发症之间存在统计学意义。通过多因素分析，术前独立预测手术时间延长的因素有急性胆囊炎、肥胖、上腹部手术史、男性和低熟练度的手术技能。
LC 中手术时间延长的风险可以根据患者的特征来评估。评估这些因素不仅有助于为每位患者优化个体预后，还有助于提高对初级外科医生手术培训的决策过程。
