Laparoscopic cholecystectomy for acute cholecystitis: safe implementation of successful strategies to reduce conversion rates
Laparoscopic cholecystectomy for acute cholecystitis: safe implementation of successful strategies to reduce conversion rates
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DOI：
10.1007/s00464-009-0374-x
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发表时间：
2009-11-01
影响因子：
3.1
通讯作者：
Madhavan, Krishnakumar
中科院分区：
文献类型：
--
作者：
Low, Shiong-Wen;Iyer, Shridhar Ganpathi;Madhavan, Krishnakumar
简介 对于接受腹腔镜胆囊切除术的急性胆囊炎患者来说，中转开腹手术的比例较高是一个众所周知的问题。本研究的目的是分析可能影响转化率的因素，并分析实施降低转化率的部门策略后的结果。材料和方法2003年7月至2007年7月，考虑对122名急性胆囊炎患者进行腹腔镜胆囊切除术。2005年7月对腹腔镜胆囊切除术的结果进行了审核，并制定了部门策略 旨在降低转化率的引入。这些策略包括由专业肝胆外科医生进行或监督的早期腹腔镜胆囊切除术（入院 72 小时内）以及手术技术的修改。本研究比较了审核前后的转化率。 48 名患者（A 组）来自预审核期，其余 74 名患者（B 组）来自审核后期。进行多变量分析以确定转开腹手术的危险因素以及所实施的策略是否导致转开手术率下降。结果 A 组患者的转开率为 29.2%。胆囊壁厚度大于 5 毫米被发现是转为开放手术的具有统计学意义的危险因素 (p = 0.028)。 B 组患者的转化率显着较低，为 6.75% (p = 0.001)。对两组患者进行多变量分析，发现胆囊壁厚度、年龄增加和预审手术时间与中转开腹手术独立相关。结论本研究表明，通过采取具体策略减少中转并通过技术改进，可以降低中转率，而术后并发症没有明显差异。胆囊壁厚度和年龄增加是中转开放手术的危险因素。
Introduction A higher rate of conversion to open surgery is a well-known problem in patients with acute cholecystitis undergoing laparoscopic cholecystectomy. The aim of this study is to analyze factors which may impact on conversion rates, and to analyze our outcomes following implementation of a departmental strategy in reducing conversion rates.Materials and methods 122 patients with acute cholecystitis were considered for laparoscopic cholecystectomy from July 2003 to July 2007. An audit of the results of laparoscopic cholecystectomy was done in July 2005 and a departmental strategy aimed at reducing the conversion rates was introduced. The strategies included early laparoscopic cholecystectomy (within 72 hours of admission), performed or supervised by specialist hepatobiliary surgeons, and modifications of operative techniques. This study compares the conversion rates before and after that audit. Forty-eight patients (group A) were from the pre-audit period and the remaining 74 (group B) were from the postaudit period. A multivariate analysis was performed to identify risk factors for conversion to open surgery and whether the strategies implemented resulted in decrease in conversion rates.Results In the group A patients, there was a conversion rate of 29.2%. Gallbladder wall thickness of greater than 5 mm was found to be a statistically significant (p = 0.028) risk factor for conversion to open surgery. In group B patients, the conversion rates were significantly lower at 6.75% (p = 0.001). Analyzing both groups of patients, Using multivariate analysis, gallbladder wall thickness, increasing age, and preaudit operative period were found to be independently associated with conversion to open surgery.Conclusions This study demonstrated that, with specific strategies to decrease conversion and with technical improvements, the conversion rates can be decreased with no demonstrable difference in postoperative complications. Gallbladder wall thickness and increasing age are risk factors for conversion to open surgery.