摘要
Abstract
Objective;To establish and evaluate a scoring system that predicts the difficulty of laparoscopic cholecystectomy ( LC ) based on preoperative ultrasonic data. Methods: With self-controlled trial, 1 078 consecutive patients undergoing LC were divided into two groups:960 in training group, 118 in testing group. Preoperative ultrasonic examination parameters including the size of gallbladder, thickness of gallbladder wall,incarcerated stone in neck of gallbladder,the number and the max diameter of stone,and the adhesions in umbilicus, Calot triangle or fundus of gallbladder were collected, postoperative variables including operating time, blood loss, conversion to open cholecystectomy,placement of drainage-tubes,postoperative complications,length of hospital stay,incision pain,gastrointestinal reaction and anal exhaust were also collected. According to the virtual difficulty of 960 training samples,they were divided into easy group and difficult group, Chi-square test and t-test were applied to choose statistically significant ultrasonic preoperative variables which formed a scoring system for ultrasonic predicting difficulty of LC. Receiver operating characteristic curve (ROC) was then applied to analyze the scoring system. Results: The variables of preoperative ultrasonic parameters with statistically significant effect were the size of gallbladder, thickness of gallbladder wall, max diameter of single stone, incarcerated stone in neck of gallbladder and the adhesions in Calot triangle and fundus of gallbladder. A scoring system for predicting the difficulty level of LC in patients was then established. The ROC curve analysis revealed that area under the curve was 0.948,which was statistically higher than that from randomizing scheme(0. 5) (P <0. 05) . The appraisal of prospective misjudge possibility was applied to the scoring system for ultrasound predicting difficulty of LC in 118 testing samples,the misjudge rate was about 4. 2% . Conclusions:The scoring system for preoperative ultrasound is a good predictor of difficulty in patients undergoing LC, and has an important significance for selection of laparoscopic operation.关键词
胆囊切除术,腹腔镜/手术难度/超声检查/预测Key words
Cholecystectomy,laparoscopic/Operative difficulty/Ultrasonography/Prediction分类
医药卫生
