腹腔镜胃肠手术中转开腹的多因素分析

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。

Analysis of Multi-fators for Conversion to Laparotomy during Laparoscopic Gastrointestinal Surgery

Objective To analyze the influencial factors for conversion to laparotomy during a laparoscopic gastrointestinal surgery. Methods A 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. Results Among 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 13=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. Conclusion Severe 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.