Trehan Munish, Mangotra Vishal, Singh Jaspal, Singla Sanjeev, Gautam Sumit Singh, Garg Ramneesh
Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Department of Plastic and Reconstructive Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Int J Appl Basic Med Res. 2023 Jan-Mar;13(1):10-15. doi: 10.4103/ijabmr.ijabmr_553_22. Epub 2023 Mar 27.
Laparoscopic cholecystectomy (LC) is established as the gold standard for benign gallbladder disease. This study was done for the evaluation of preoperative scoring system given by Randhawa and Pujahari considering various preoperative parameters to predict difficulty in LC.
Preoperative prediction of difficult LC using a scoring system considering various preoperative factors in elective/interval LC to predict difficult gallbladder.
A prospective study of 120 patients admitted for LC from January 2020 to June 2021 was analyzed.
All the patients were evaluated on the basis of Randhawa and Pujahari scoring system with the following variables: age >50 years, male sex, body mass index 25.1-27.5 and >27.5 kg/m, previous abdominal surgery, prior hospitalization for gallstone disease, palpable gallbladder, gallbladder wall thickening, impacted stone, and pericholecystic collection. Each variable had given a score. Based on these findings, the surgical procedure was defined as easy, difficult, and very difficult.
One hundred and twenty cases satisfying the inclusion criteria were studied comparing different variables and assigned preoperative scoring. A score >5 was considered significant and compared with intraoperative findings. Out of 53 patients having preoperative scores >5, 40 were difficult gallbladders and 13 were easy to operate. Prediction came true in 93.0% of difficult cases and 83.1% of easy cases.
From this study, we can conclude that the preoperative scoring system is statistically reliable to predict difficulty in LC in the majority of the cases (area under receiver operator characteristics = 0.935).
腹腔镜胆囊切除术（LC）已成为治疗良性胆囊疾病的金标准。本研究旨在评估Randhawa和Pujahari提出的术前评分系统，该系统考虑了各种术前参数以预测LC手术的难度。
在择期/限期LC手术中，使用考虑各种术前因素的评分系统对困难LC进行术前预测，以预判胆囊情况。
对2020年1月至2021年6月收治的120例行LC手术的患者进行前瞻性研究分析。
所有患者均根据Randhawa和Pujahari评分系统进行评估，变量如下：年龄>50岁、男性、体重指数25.1 - 27.5及>27.5kg/m²、既往腹部手术史、既往因胆结石疾病住院史、可触及的胆囊、胆囊壁增厚、嵌顿结石及胆囊周围积液。每个变量都有相应分值。基于这些结果，将手术过程定义为容易、困难和非常困难。
对120例符合纳入标准的病例进行研究，比较不同变量并进行术前评分。评分>5被认为具有显著性，并与术中结果进行比较。在53例术前评分>5的患者中，40例胆囊手术困难，13例手术操作容易。93.0%的困难病例和83.1%的容易病例预测正确。
从本研究可以得出结论，术前评分系统在大多数情况下对预测LC手术难度具有统计学可靠性（受试者工作特征曲线下面积 = 0.935）。
