Department of Hepatobiliary Surgery, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang People's Hospital, Dongyang, Zhejiang, China.
Surg Laparosc Endosc Percutan Tech. 2024 Oct 1;34(5):479-484. doi: 10.1097/SLE.0000000000001304.
The predictors of difficulty performing laparoscopic cholecystectomy (LC) following percutaneous transhepatic gallbladder drainage (PTGBD) for grade II acute cholecystitis have not been clearly understood.
This retrospective study was performed between January 2019 and February 2023 and involved 102 eligible patients with grade II acute cholecystitis. Patients were categorized into 2 groups: difficult LC group (n=14) and nondifficult LC group (n=88). Preoperative characteristics and postoperative outcomes were analyzed, and a logistic regression model was used for multivariate analyses of the significant factors identified in the univariate analyses.
Logistic multivariable regression analysis revealed that C-reactive protein (CRP) levels (odds ratio [OR]: 1.028, 95% confidence interval [CI]: 1.013-1.044; P <0.05), and time intervals between PTGBD and LC (OR: 1.047, 95% CI: 1.003-1.092; P =0.034) were independent predictors of difficult LC. When preoperative CRP was >154 mg/L, LC difficulty, blood loss, and operative time increased ( P <0.05, P =0.01, P =0.01, respectively) compared with CRP <154 mg/L. Difficult LC, increased blood loss, and longer operative time occurred more frequently when the interval between PTGBD and LC was >35 days compared with <35 days ( P <0.05, P =0.003, P =0.002, respectively).
CRP levels >154 mg/L and intervals between PTGBD and LC exceeding 35 days are associated with greater LC difficulty.
经皮经肝胆囊引流术（PTGBD）治疗 II 级急性胆囊炎后行腹腔镜胆囊切除术（LC）的难度预测因素尚不清楚。
本回顾性研究于 2019 年 1 月至 2023 年 2 月进行，共纳入 102 例符合条件的 II 级急性胆囊炎患者。患者分为 2 组：困难 LC 组（n=14）和非困难 LC 组（n=88）。分析了术前特征和术后结果，并对单因素分析中确定的显著因素进行了 logistic 多变量分析。
logistic 多变量回归分析显示，C 反应蛋白（CRP）水平（比值比[OR]：1.028，95%置信区间[CI]：1.013-1.044；P<0.05）和 PTGBD 与 LC 之间的时间间隔（OR：1.047，95%CI：1.003-1.092；P=0.034）是 LC 难度的独立预测因素。当术前 CRP>154mg/L 时，LC 难度、出血量和手术时间均增加（P<0.05，P=0.01，P=0.01，分别），而 CRP<154mg/L 时则不然。与 PTGBD 与 LC 间隔<35 天相比，间隔>35 天时 LC 难度增加、出血量增加和手术时间延长更为常见（P<0.05，P=0.003，P=0.002，分别）。
CRP 水平>154mg/L 和 PTGBD 与 LC 之间的时间间隔超过 35 天与更大的 LC 难度相关。
