Ben-Ishay Offir, Zeltser Marina, Kluger Yoram
Offir Ben-Ishay, Marina Zeltser, Yoram Kluger, Surgical Oncology, Pancreatic and Hepatobiliary Surgery Service, Department of General Surgery, Division of Surgery, Rambam Health Care Campus, Haifa 35254, Israel.
World J Gastrointest Surg. 2017 Jun 27;9(6):149-152. doi: 10.4240/wjgs.v9.i6.149.
To evaluate the value of blood testing after elective laparoscopic cholecystectomy and its association with procedure related complications.
Charts of all patients undergoing elective laparoscopic cholecystectomy from January 2013 through December 2014 were reviewed retrospectively for demographics, indication for surgery, operative course and outcome. In our institution the decision to perform postoperative blood analysis is left for the discretion of the surgeon, therefore we had the possibility to compare the results of those who had blood analyses results to those who did not. Analysis was performed to identify variables associated with the decision to perform postoperative blood tests. Subsequently a univariate and multivariate analyses was performed comparing the two cohorts. Secondary subgroup analysis was performed to identify factors associated with procedure related complications.
Five hundred and thirty-two elective laparoscopic cholecystectomies for symptomatic gallstones were performed during the study period. Sixty-four percent of the patients ( = 340) had blood tests taken post operatively. Patients that had laboratory tests taken were older ( = 0.006, OR = 1.01), had longer surgery ( < 0.001, OR = 3.22) had more drains placed ( < 0.001, OR = 3.2) and stayed longer in the hospital ( < 0.001, OR = 1.2). A subgroup analysis of the patients who experienced complications revealed longer stay in the hospital ( < 0.001), higher body mass index (BMI) ( = 0.04, OR = 1.08), increased rates of drain placement ( = 0.006, OR = 3.1) and higher conversion rates ( = 0.01, OR = 14.6). Postoperative blood tests withdrawals were not associated with complications ( = 0.44). On Multivariate analysis BMI and drain placement were independently associated with complications.
The current study indicate that routine postoperative blood tests after elective laparoscopic cholecystectomy for symptomatic gallstones does not predict complications and may have an added benefit in diagnosis and management of cases were the surgeon encountered true technical difficulty during surgery.
评估择期腹腔镜胆囊切除术后血液检测的价值及其与手术相关并发症的关联。
回顾性分析2013年1月至2014年12月期间所有接受择期腹腔镜胆囊切除术患者的病历，包括人口统计学资料、手术指征、手术过程及结果。在我们机构，术后血液分析的决定由外科医生自行决定，因此我们能够比较有血液分析结果的患者与没有血液分析结果的患者的情况。进行分析以确定与术后血液检测决定相关的变量。随后对两个队列进行单因素和多因素分析。进行次要亚组分析以确定与手术相关并发症相关的因素。
在研究期间共进行了532例有症状胆结石的择期腹腔镜胆囊切除术。64%的患者（n = 340）术后进行了血液检测。进行实验室检测的患者年龄较大（P = 0.006，OR = 1.01），手术时间较长（P < 0.001，OR = 3.22），放置引流管更多（P < 0.001，OR = 3.2），住院时间更长（P < 0.001，OR = 1.2）。对发生并发症的患者进行亚组分析显示，住院时间更长（P < 0.001），体重指数（BMI）更高（P = 0.04，OR = 1.08），引流管放置率增加（P = 0.006，OR = 3.1），转换率更高（P = 0.01，OR = 14.6）。术后血液检测的取消与并发症无关（P = 0.44）。多因素分析显示，BMI和引流管放置与并发症独立相关。
当前研究表明，有症状胆结石择期腹腔镜胆囊切除术后的常规术后血液检测不能预测并发症，且在外科医生在手术中遇到真正技术困难的病例的诊断和管理中可能具有额外益处。
