Gynaecology 2 Unit (Endometriosis and Pelvic Pain), Royal Women's Hospital, Melbourne (all authors).
Gynaecology 2 Unit (Endometriosis and Pelvic Pain), Royal Women's Hospital, Melbourne (all authors); Department of Obstetrics and Gynecology, University of Melbourne, Parkville (Drs. Healey and Cheng), Victoria, Australia.
J Minim Invasive Gynecol. 2021 Oct;28(10):1786-1794. doi: 10.1016/j.jmig.2021.03.013. Epub 2021 Apr 20.
To describe cases of conversion from gynecologic laparoscopy to open surgery and to assess risk factors for conversion and conversion outcomes.
A retrospective case-control study.
Tertiary referral hospital in Melbourne, Australia.
Eighty-five cases of conversion from laparoscopy to laparotomy and 170 controls matched by age, surgical date, and gynecologic unit from 2006 to 2017.
Demographic, clinical, and surgical data were collected and compared between the study groups. Logistic regression was performed to identify preoperative and intraoperative risk factors for conversion.
Rate of conversion during the study period was 0.7%. The most common indication for conversion was unexpected surgical complexity (67% of cases), which included severe adhesive disease, specimen size, severe pathology, and inadequate views. Factors that were significantly associated with risk of conversion in multivariate analysis were previous pelvic inflammatory disease (adjusted odds ratio [aOR] 5.16; 95% confidence interval [CI], 1.35-19.71; p = .02), previous open surgery (aOR 3.62; 95% CI, 1.52-8.58; p <.01), history of endometriosis (aOR 2.96; 95% CI, 1.17-7.50; p = .02), and elevated body mass index (aOR 1.07; 95% CI, 1.01-1.13; p = .02). As compared with current surgery for endometriosis, odds of conversion were higher in surgeries for emergency indications (aOR 5.40; 95% CI, 1.53-18.98; p <.01), uterine pathologies (aOR 3.34; 95% CI, 1.10-10.12; p = .03), and adnexal pathologies (aOR 2.76; 95% CI, 1.19-6.40; p = .02). With the inclusion of intraoperative factors, surgical adhesions were also found to be associated with conversion (aOR 3.19; 95% CI, 1.30-7.85; p = .01). Most skilled laparoscopic surgeon level as defined by the Australasian Gynaecological Endoscopy and Surgery Society was not associated with conversion risk. Conversion to laparotomy was associated with a higher rate of intraoperative and postoperative complications and prolonged length of stay.
Conversion to laparotomy is a rare but very important clinical outcome measure of laparoscopic surgery. Understanding the factors contributing to conversion and perioperative outcomes may help clinicians to identify and counsel patients before surgery and to reduce surgical morbidity.
描述从妇科腹腔镜转为开腹手术的病例，并评估转为开腹手术的风险因素和转归。
回顾性病例对照研究。
澳大利亚墨尔本的一家三级转诊医院。
2006 年至 2017 年期间，85 例从腹腔镜转为开腹手术的病例和 170 例年龄、手术日期和妇科科室匹配的对照组。
收集并比较研究组的人口统计学、临床和手术数据。采用 logistic 回归分析确定术前和术中转为开腹手术的风险因素。
研究期间的中转率为 0.7%。中转最常见的原因是手术复杂性的意外增加（67%的病例），包括严重粘连疾病、标本大小、严重病变和术野不佳。多因素分析显示，与中转风险相关的因素有既往盆腔炎（调整比值比[aOR]5.16；95%置信区间[CI]1.35-19.71；p=0.02）、既往开腹手术（aOR 3.62；95%CI，1.52-8.58；p<.01）、子宫内膜异位症病史（aOR 2.96；95%CI，1.17-7.50；p=0.02）和体重指数升高（aOR 1.07；95%CI，1.01-1.13；p=0.02）。与当前子宫内膜异位症手术相比，紧急手术指征（aOR 5.40；95%CI，1.53-18.98；p<.01）、子宫病变（aOR 3.34；95%CI，1.10-10.12；p=0.03）和附件病变（aOR 2.76；95%CI，1.19-6.40；p=0.02）的中转风险更高。纳入术中因素后，发现手术粘连也与中转相关（aOR 3.19；95%CI，1.30-7.85；p=0.01）。按澳大利亚妇科内镜和外科协会的分类，最熟练的腹腔镜手术医生级别与中转风险无关。转为开腹手术与术中及术后并发症发生率较高和住院时间延长有关。
转为开腹手术是腹腔镜手术的一个罕见但非常重要的临床转归指标。了解导致中转的因素和围手术期结局，可能有助于临床医生在术前识别和告知患者，并降低手术发病率。
