Avci Mehmet Alperen, Akgün Can, Buk Omer, Karadan Dilara
General Surgery, Samsun University, Samsun, TUR.
General Surgery, Samsun Research and Training Hospital, Samsun, TUR.
Cureus. 2024 Aug 31;16(8):e68290. doi: 10.7759/cureus.68290. eCollection 2024 Aug.
Backgrounds Laparoscopic cholecystectomy (LC) is the gold standard for surgical removal of gallbladder today. In challenging cholecystectomy cases, conversion to an open technique may be necessary. Therefore, the preoperative prediction of conversion to open technique holds significant importance for patient safety and surgical strategy. In the literature, conversion to open cholecystectomy has been associated with many contradictory predictive factors. The aim of this study is to identify and comprehensively evaluate the predictive laboratory parameters and ratios associated with the conversion from laparoscopic to open cholecystectomy. Methods In this historical cohort study, the data of patients who were scheduled for and underwent LC between January 1, 2018, and September 1, 2023, were retrospectively evaluated. The preoperative laboratory findings and surgical notes of the patients were reviewed retrospectively from the archives. The correlation between patient data and the cholecystectomy groups was analyzed, and comparisons were made between the groups. Results All 160 patients initially underwent a laparoscopic approach. In emergency cases, a statistically significant association was found between lymphocyte count (p = 0.017) and lymphocyte-to-monocyte ratio (LMR) (p = 0.041) with operations completed laparoscopically and between neutrophil-to-lymphocyte ratio (NLR) (p = 0.007) and Systemic Inflammatory Response Index (SIRI) (p = 0.031) with operations converted to open surgery. In elective cases, gamma-glutamyl transferase (GGT) (p = 0.024) and total bilirubin (TBIL) (p = 0.003) were found to have a statistically significant association with operations converted to open surgery. In the logistic regression analysis, hematological parameters and ratios were not found to have a statistically significant relationship in predicting the conversion to open surgery. Conclusion Although significant differences were observed in laboratory parameters and derived ratios such as the NLR and LMR, logistic regression analysis did not identify any of these measures as significant predictors of conversion from laparoscopic to open surgery. Further prospective studies with larger sample sizes are needed in this area.
背景 腹腔镜胆囊切除术（LC）是目前手术切除胆囊的金标准。在具有挑战性的胆囊切除病例中，可能需要转为开放手术技术。因此，术前预测转为开放手术技术对于患者安全和手术策略具有重要意义。在文献中，转为开放胆囊切除术与许多相互矛盾的预测因素相关。本研究的目的是识别并综合评估与从腹腔镜胆囊切除术转为开放胆囊切除术相关的预测性实验室参数和比率。
方法 在这项历史性队列研究中，对2018年1月1日至2023年9月1日期间计划进行并接受LC的患者数据进行回顾性评估。从档案中回顾性审查患者的术前实验室检查结果和手术记录。分析患者数据与胆囊切除组之间的相关性，并在组间进行比较。
结果 所有160例患者最初均采用腹腔镜手术方式。在急诊病例中，淋巴细胞计数（p = 0.0l7）和淋巴细胞与单核细胞比率（LMR）（p = 0.041）与腹腔镜完成手术之间存在统计学显著关联，中性粒细胞与淋巴细胞比率（NLR）（p = 0.007）和全身炎症反应指数（SIRI）（p = 0.031）与转为开放手术的手术之间存在统计学显著关联。在择期病例中，发现γ-谷氨酰转移酶（GGT）（p = 0.024）和总胆红素（TBIL）（p = 0.003）与转为开放手术的手术存在统计学显著关联。在逻辑回归分析中，未发现血液学参数和比率在预测转为开放手术方面存在统计学显著关系。
结论 尽管在实验室参数以及诸如NLR和LMR等衍生比率方面观察到显著差异，但逻辑回归分析未将这些指标中的任何一项确定为从腹腔镜手术转为开放手术的显著预测指标。该领域需要进一步开展更大样本量的前瞻性研究。
