Kamran Khawar, Afridi Zia-Ud-Din, Muqim Rooh-Ul, Khalil Jawad
Department of Surgery, Surgical A Unit, Khyber Teaching Hospital, Peshawar, Pakistan.
Asian J Endosc Surg. 2013 Feb;6(1):21-5. doi: 10.1111/j.1758-5910.2012.00152.x. Epub 2012 Sep 12.
The aim of our study was to determine the effect of sex on the outcome of laparoscopic cholecystectomy in terms of operative time, conversion to open cholecystectomy, postoperative complications and mean hospital stay.
In this retrospective observational study, we analyzed the medical records of 2061 patients who underwent laparoscopic cholecystectomy in the surgical department of Khyber Teaching Hospital (Peshawar, Pakistan) between March 2008 and January 2010. χ(2) test and t-test were respectively used to analyze categorical and numerical variables. P ≤ 0.05 was considered significant.
The study included 1772 female and 289 male patients. The mean age for male patients was 44.07 ± 11.91 years compared to 41.29 ± 12.18 years for female patients (P = 0.706). Laparoscopic cholecystectomy was successfully completed in 1996 patients. The conversion rate was higher in men (P < 0.001), and the mean operating time was longer in men (P < 0.001). Bile duct injuries occurred more frequently in men (P < 0.001). Gallbladder perforation and gallstone spillage also occurred more commonly in men (P = 0.001); similarly severe inflammation was reported more in male patients (P = 0001). There were no statistically significant differences in mean hospital stay, wound infection and port-site herniation between men and women. Multivariate regression analysis showed that the male sex is an independent risk factor for conversion to open cholecystectomy (odds ratio = 2.65, 95% confidence interval: 1.03-6.94, P = 0.041) and biliary injuries (odds ratio = 0.95, 95% confidence interval: 0.91-0.99, P-value = 0.036).
Laparoscopic cholecystectomy is often challenging in men on account of more adhesions and inflammation. This leads to higher conversion rates and more postoperative complications. Optimized planning and a more experienced operating surgeon may help overcome these problems.
我们研究的目的是从手术时间、转为开腹胆囊切除术、术后并发症及平均住院时间方面确定性别对腹腔镜胆囊切除术结果的影响。
在这项回顾性观察研究中，我们分析了2008年3月至2010年1月间在开伯尔教学医院（巴基斯坦白沙瓦）外科接受腹腔镜胆囊切除术的2061例患者的病历。分别采用χ²检验和t检验分析分类变量和数值变量。P≤0.05被认为具有统计学意义。
该研究纳入了1772例女性患者和289例男性患者。男性患者的平均年龄为44.07±11.91岁，女性患者为41.29±12.18岁（P = 0.706）。1996例患者成功完成了腹腔镜胆囊切除术。男性的中转率更高（P < 0.001），男性的平均手术时间更长（P < 0.001）。男性胆管损伤更常见（P < 0.001）。胆囊穿孔和胆石溢出在男性中也更常见（P = 0.001）；同样，男性患者中重度炎症的报告更多（P = 0.001）。男性和女性在平均住院时间、伤口感染和切口疝方面无统计学显著差异。多因素回归分析显示，男性是转为开腹胆囊切除术（比值比 = 2.65，95%置信区间：1.03 - 6.94，P = 0.041）和胆管损伤（比值比 = 0.95，95%置信区间：0.91 - 0.99，P值 = 0.036）的独立危险因素。
由于粘连和炎症更多，腹腔镜胆囊切除术在男性患者中往往具有挑战性。这导致更高的中转率和更多的术后并发症。优化的手术规划和经验更丰富的手术医生可能有助于克服这些问题。
