[1]李临海,王昆华,龚昆梅,等.腹腔镜胃肠手术中转开腹的多因素分析[J].中国微创外科杂志,2012,12(11):987-989.
　Li Linhai,Wang Kunhua,Gong Kunmei,et al.Analysis of Multifators for Conversion to Laparotomy during Laparoscopic Gastrointestinal Surgery[J].Chinese Journal of Minimally Invasive Surgery,2012,12(11):987-989.
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腹腔镜胃肠手术中转开腹的多因素分析()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
12
期数:
2012年11期
页码:
987-989
栏目:
出版日期:
2012-11-20

文章信息/Info

Title:
Analysis of Multifators for Conversion to Laparotomy during Laparoscopic Gastrointestinal Surgery
作者:
李临海; 王昆华; 龚昆梅; 郭世奎; 肖乐; 刘为军
云南省第一人民医院普外一科昆明理工大学昆华医院云南省肠外肠内营养研究中心，昆明650032
Author(s):
Li Linhai;  Wang Kunhua;  Gong Kunmei;  et al
Department of General Surgery, First People’s Hospital of Yunnan Province, Kunming 650032, China
关键词:
胃肠手术; 腹腔镜; 中转开腹
Keywords:
Gastrointestinal Surgery; Laparoscopy; Conversion to open surgery
分类号:
R656.6
文献标志码:
A
摘要:
目的 探讨腹腔镜胃肠手术中转开腹的影响因素。方法 回顾性分析我院2005年5月～2011年4月213例胃肠道癌行腹腔镜手术的临床资料，其中胃癌24例，直肠癌118例，右半结肠癌22例，左半结肠癌25例，小肠癌24例。采用多元logistic回归分析腹腔镜胃肠手术中转开腹的原因。结果 中转开腹25例，中转率为11.7%(25/213)。腹腔镜中转开腹的影响因素为粘连程度（β=1.792,P=0.000,95%CI:0.073~0.785）、术中出血（β=1.454,P=0.036,95%CI:-0.386~0.286）、肿瘤分期（β=0.874,P=0.039,95%CI:-0.206~0.270）、肿瘤分化程度（β=1000,P=0.004,95%CI:0.015~0183），患者年龄、性别和肿瘤部位与中转开腹无关。结论 腹腔镜胃肠手术中转开腹的主要原因是粘连程度和术中出血。术前充分评估，严格选择适应证，并根据术中具体情况及术者实际水平，决定中转开腹时机，是降低中转率，减少并发症的重要措施。
Abstract:
ObjectiveTo analyze the influencial factors for conversion to laparotomy during a laparoscopic gastrointestinal surgery. MethodsA retrospective study on the clinical data of 213 patients with gastrointestinal cancer, who received laparoscopic surgery in our hospital from May 2005 to April 2011. Among the cases, carcinoma was detected in the stomach in 24 patients, in the rectum in 118, the right colon in 22, the left colon in 25, and in the intestine in the other 24. The causes of conversion to laparotomy was analyzed with Logistic regression. ResultsAmong the 213 patients, 25 cases were converted to open surgery (11.7%). Severe adhesion and intraoperative blood loss were major factors for the conversion (β=1.792, P=0.000, 95%CI: 0.073 - 0.785; and β=1.454, P=0.036, 95%CI: -0.386 - 0.286; respectively), followed by tumor stage and tumor differentiation (β=0874, P=0.039, 95%CI: -0.206 - 0.270; and β=1.000, P=0.004, 95%CI: 0.015 - 0.183). The age and sex of the patients and the location of the tumor were not related to conversion to open surgery. ConclusionSevere adhesion and intraoperative blood loss are the main causes of conversion to open surgery during a laparoscopic procedure for gastrointestinal cancer. To decrease the rate of conversion, and avoid surgical complications, we recommend a sufficient preoperative evaluation and strict surgical indication. And the timing for conversion to open surgery shall be determined individually.

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备注/Memo

备注/Memo:
王昆华通讯作者，Email: wangkunhua1@medmail.com.cn
更新日期/Last Update: 2013-03-27