{"title":"从术前临床因素和影像学表现预测急性胆囊炎腹腔镜胆囊切除术的难度。","authors":"Hung-Yu Chung, Shang-Yu Wang, Yu-Liang Hung, Ker-En Lee, Huan-Wu Chen, Chun-Yi Tsai, Jun-Te Hsu, Ta-Sen Yeh, Chun-Nan Yeh, Yi-Yin Jan","doi":"10.1177/10926429251379864","DOIUrl":null,"url":null,"abstract":"<p><p><b><i>Purpose:</i></b> This study aimed to identify predictive clinical factors and computed tomography (CT) findings for difficult laparoscopic cholecystectomy (LC) in patients with acute cholecystitis (AC). <b><i>Methods:</i></b> We retrospectively reviewed 549 patients with AC who underwent LC following preoperative CT scans from January 2011 to August 2020. Difficult LC was defined as requiring conversion to laparotomy or subtotal cholecystectomy, blood loss >500 mL, operative time significantly exceeding average, or bile duct injury. Clinical characteristics and specific CT findings were analyzed using univariate and multivariate logistic regression. <b><i>Results:</i></b> Twenty-seven patients (4.9%) experienced difficult LC. Multivariate analysis identified body mass index (BMI) >30 kg/m<sup>2</sup> (odds ratio [OR] = 4.70, 95% confidence interval [CI]: 1.86-11.92; <i>P</i> = .004) and C-reactive protein (CRP) ≥60 mg/L (OR = 3.12, 95% CI: 1.31-7.44; <i>P</i> = .01) as independent predictors. Radiological findings from CT, such as peri-gallbladder fluid and fat stranding, demonstrated no significance statistically. <b><i>Conclusions:</i></b> High BMI and elevated CRP levels were significant independent predictors for difficult LC in patients with AC. Preoperative CT findings alone did not predict surgical difficulty, suggesting clinical factors should remain the primary consideration in preoperative assessment.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":" ","pages":""},"PeriodicalIF":1.1000,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Prediction of Difficult Laparoscopic Cholecystectomy for Acute Cholecystitis from Preoperative Clinical Factors and Radiological Findings.\",\"authors\":\"Hung-Yu Chung, Shang-Yu Wang, Yu-Liang Hung, Ker-En Lee, Huan-Wu Chen, Chun-Yi Tsai, Jun-Te Hsu, Ta-Sen Yeh, Chun-Nan Yeh, Yi-Yin Jan\",\"doi\":\"10.1177/10926429251379864\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b><i>Purpose:</i></b> This study aimed to identify predictive clinical factors and computed tomography (CT) findings for difficult laparoscopic cholecystectomy (LC) in patients with acute cholecystitis (AC). <b><i>Methods:</i></b> We retrospectively reviewed 549 patients with AC who underwent LC following preoperative CT scans from January 2011 to August 2020. Difficult LC was defined as requiring conversion to laparotomy or subtotal cholecystectomy, blood loss >500 mL, operative time significantly exceeding average, or bile duct injury. Clinical characteristics and specific CT findings were analyzed using univariate and multivariate logistic regression. <b><i>Results:</i></b> Twenty-seven patients (4.9%) experienced difficult LC. Multivariate analysis identified body mass index (BMI) >30 kg/m<sup>2</sup> (odds ratio [OR] = 4.70, 95% confidence interval [CI]: 1.86-11.92; <i>P</i> = .004) and C-reactive protein (CRP) ≥60 mg/L (OR = 3.12, 95% CI: 1.31-7.44; <i>P</i> = .01) as independent predictors. Radiological findings from CT, such as peri-gallbladder fluid and fat stranding, demonstrated no significance statistically. <b><i>Conclusions:</i></b> High BMI and elevated CRP levels were significant independent predictors for difficult LC in patients with AC. Preoperative CT findings alone did not predict surgical difficulty, suggesting clinical factors should remain the primary consideration in preoperative assessment.</p>\",\"PeriodicalId\":50166,\"journal\":{\"name\":\"Journal of Laparoendoscopic & Advanced Surgical Techniques\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2025-09-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Laparoendoscopic & Advanced Surgical Techniques\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/10926429251379864\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Laparoendoscopic & Advanced Surgical Techniques","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/10926429251379864","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
摘要
目的:本研究旨在确定急性胆囊炎(AC)患者腹腔镜胆囊切除术(LC)的预测临床因素和计算机断层扫描(CT)结果。方法:我们回顾性分析了2011年1月至2020年8月549例术前CT扫描后行LC的AC患者。困难LC定义为需要转开腹或胆囊次全切除术,出血量大于500ml,手术时间明显超过平均水平,或胆管损伤。采用单因素和多因素logistic回归分析临床特征和特异性CT表现。结果:27例(4.9%)出现难治性LC。多因素分析确定体重指数(BMI)为30 kg/m2(比值比[OR] = 4.70, 95%可信区间[CI]: 1.86-11.92; P = 0.004)和c反应蛋白(CRP)≥60 mg/L (OR = 3.12, 95% CI: 1.31-7.44; P = 0.01)为独立预测因子。CT的影像学表现,如胆囊周围积液和脂肪搁浅,在统计学上没有显著性。结论:高BMI和CRP水平升高是AC患者难辨LC的重要独立预测因素。术前CT检查结果不能单独预测手术难度,提示临床因素仍应是术前评估的首要考虑因素。
The Prediction of Difficult Laparoscopic Cholecystectomy for Acute Cholecystitis from Preoperative Clinical Factors and Radiological Findings.
Purpose: This study aimed to identify predictive clinical factors and computed tomography (CT) findings for difficult laparoscopic cholecystectomy (LC) in patients with acute cholecystitis (AC). Methods: We retrospectively reviewed 549 patients with AC who underwent LC following preoperative CT scans from January 2011 to August 2020. Difficult LC was defined as requiring conversion to laparotomy or subtotal cholecystectomy, blood loss >500 mL, operative time significantly exceeding average, or bile duct injury. Clinical characteristics and specific CT findings were analyzed using univariate and multivariate logistic regression. Results: Twenty-seven patients (4.9%) experienced difficult LC. Multivariate analysis identified body mass index (BMI) >30 kg/m2 (odds ratio [OR] = 4.70, 95% confidence interval [CI]: 1.86-11.92; P = .004) and C-reactive protein (CRP) ≥60 mg/L (OR = 3.12, 95% CI: 1.31-7.44; P = .01) as independent predictors. Radiological findings from CT, such as peri-gallbladder fluid and fat stranding, demonstrated no significance statistically. Conclusions: High BMI and elevated CRP levels were significant independent predictors for difficult LC in patients with AC. Preoperative CT findings alone did not predict surgical difficulty, suggesting clinical factors should remain the primary consideration in preoperative assessment.
期刊介绍:
Journal of Laparoendoscopic & Advanced Surgical Techniques (JLAST) is the leading international peer-reviewed journal for practicing surgeons who want to keep up with the latest thinking and advanced surgical technologies in laparoscopy, endoscopy, NOTES, and robotics. The Journal is ideally suited to surgeons who are early adopters of new technology and techniques. Recognizing that many new technologies and techniques have significant overlap with several surgical specialties, JLAST is the first journal to focus on these topics both in general and pediatric surgery, and includes other surgical subspecialties such as: urology, gynecologic surgery, thoracic surgery, and more.