Altuntas Yunus Emre, Oncel Mustafa, Haksal Mustafa, Kement Metin, Gundogdu Ersin, Aksakal Nihat, Gezen Fazli Cem
Department of General Surgery, Kartal Training and Research Hospital, Istanbul, Turkey.
Department of General Surgery, Medipol University Faculty of Medicine, Istanbul, Turkey.
North Clin Istanb. 2018 Jan 12;5(1):47-53. doi: 10.14744/nci.2017.88155. eCollection 2018.
This study aimed to reveal the risk factors and outcomes of gallbladder perforation (GP) during laparoscopic cholecystectomy.
Videotapes of all patients who underwent an elective cholecystectomy at our department were retrospectively analyzed, and the patients were divided into two groups based on the presence of GP. The possible risk factors and early outcomes were analyzed.
In total, 664 patients [524 (78.9%) females, 49.7±13.4 years of age] were observed, and GP occurred in 240 (36.1%) patients, mostly while dissecting the gallbladder from its bed (n=197, 82.1%). GP was not recorded in the operation notes in 177 (73.8%) cases. Among the studied parameters, there was no significant risk factor for GP, except preoperatively elevated alanine transaminase level (p=0.005), but the sensitivity and specificity of this measure in predicting GP were 14.2% and 7.4%, respectively. The two groups had similar outcomes, but the operation time (35.4±17.5 vs 41.4±18.7 min, p=0.000) and incidence of drain use (25% vs 45.8%, p=0.000) increased in the GP group.
The present study reveals that GP occurs in 36.1% of patients who undergo laparoscopic elective cholecystectomy, but it may not be recorded in most cases. We did not find any reliable risk factor that increases the possibility of GP. GP causes an increase in the operation time and incidence of drain use; however, the other outcomes were found to be similar in patients with GP and those without.
本研究旨在揭示腹腔镜胆囊切除术期间胆囊穿孔（GP）的危险因素及结局。
回顾性分析在我科接受择期胆囊切除术的所有患者的录像资料，根据是否发生GP将患者分为两组。分析可能的危险因素及早期结局。
共观察664例患者[524例（78.9%）为女性，年龄49.7±13.4岁]，240例（36.1%）患者发生GP，大多发生在从胆囊床分离胆囊时（n = 197，82.1%）。177例（73.8%）病例的手术记录中未记录GP。在所研究的参数中，除术前丙氨酸转氨酶水平升高外（p = 0.005），没有显著的GP危险因素，但该指标预测GP的敏感性和特异性分别为14.2%和7.4%。两组结局相似，但GP组的手术时间（35.4±17.5 vs 41.4±18.7分钟，p = 0.000）和引流管使用发生率（25% vs 45.8%，p = 0.000）增加。
本研究表明，36.1%接受腹腔镜择期胆囊切除术的患者发生GP，但大多数情况下可能未记录。我们未发现任何增加GP可能性的可靠危险因素。GP导致手术时间和引流管使用发生率增加；然而，发现发生GP和未发生GP的患者的其他结局相似。
