Sanabria J R, Gallinger S, Croxford R, Strasberg S M
Department of Surgery, Mount Sinai Hospital, Toronto.
J Am Coll Surg. 1994 Dec;179(6):696-704.
Most cholecystectomies can be performed using a laparoscopic approach. However, 3 to 10 percent of laparoscopic cholecystectomies (LC) must be converted to open cholecystectomies (OC) and preoperative factors that predict risk for conversion are still not defined.
Preoperative and intraoperative data were collected and analyzed from 628 patients who were scheduled for elective LC by two surgeons in an academic institution. Logistic regression was performed on data from two groups of patients: LC completed, 596 patients (95 percent) and LC converted, 32 patients (5 percent).
Elective LC was accomplished with no common bile duct injuries, low morbidity rate (7.3 percent), and zero mortality rate. Both patient and surgeon factors predicted conversion from LC to OC. Older patients (65 years of age or older, (p < 0.01), males (p < 0.01), and patients with multiple attacks (ten or more) of biliary colic (p < 0.01), or a documented history of acute cholecystitis (p < 0.01) had a greater risk for conversion. Both surgeons had higher rates of conversion (p < 0.05) during the learning phase (fewer than 50 LC) of their experience.
Risk factors for conversion may be predicted and awareness of these factors should help in the selection of the appropriate procedure for patients and in selection of cases for resident training.
大多数胆囊切除术可采用腹腔镜方法进行。然而，3%至10%的腹腔镜胆囊切除术（LC）必须转为开腹胆囊切除术（OC），且预测转为开腹手术风险的术前因素仍未明确。
收集并分析了某学术机构两位外科医生为628例计划行择期LC的患者所记录的术前和术中数据。对两组患者的数据进行逻辑回归分析：完成LC的患者596例（95%），转为OC的患者32例（5%）。
择期LC完成时无胆总管损伤，发病率低（7.3%），死亡率为零。患者因素和外科医生因素均预测了从LC转为OC的情况。年龄较大的患者（65岁及以上，p<0.01）、男性（p<0.01）、有多次（十次或以上）胆绞痛发作的患者（p<0.01）或有急性胆囊炎病史记录的患者（p<0.01）转为开腹手术的风险更高。两位外科医生在其经验的学习阶段（少于50例LC）转换率均较高（p<0.05）。
可以预测转为开腹手术的风险因素，了解这些因素有助于为患者选择合适的手术方式以及为住院医师培训选择病例。
