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目的研究探讨腹腔镜胃肠手术中转开腹的影响因素。方法 275例实施腹腔镜胃肠择期手术的患者,按照患者是否发生中转开腹分为腹腔镜组与中转开腹组,探讨影响中转开腹的因素。结果 275例实施腹腔镜胃肠择期手术的患者中,24例患者因复杂因素造成术中转行开腹手术根治处理(中转开腹组),余下251例顺利实施手术(腹腔镜组)。两组患者年龄、性别、肿瘤部位比较差异无统计学意义(P>0.05),两组肿瘤分期、肿瘤分化类型及病变程度、术中出血程度与病灶组织粘连情况比较差异具有统计学意义(P<0.05)。Logistic多元回归分析显示,术中出血程度、病灶组织粘连情况、肿瘤分期及肿瘤分化类型及病变程度为腹腔镜胃肠择期手术中转开腹的影响因素(P<0.05)。结论腹腔镜胃肠手术中转开腹影响因素复杂,在临床手术中需严格控制操作流程,明确适应证,结合患者自身手术风险及实际病情变化合适处理,将中转开腹发生率降至最低。
Objective To study the influencing factors of laparoscopic gastrointestinal surgery in laparotomy. Methods A total of 275 patients undergoing laparoscopic surgery for gastrointestinal elective surgery were divided into laparoscopic group and laparotomy group according to whether the patients had transit laparotomy. Results Of the 275 patients who underwent laparoscopic gastrointestinal surgery, 24 patients underwent open surgery due to complicated factors (transit laparotomy) and the remaining 251 patients underwent laparoscopic surgery. There was no significant difference in age, sex and tumor location between the two groups (P> 0.05). There were significant differences in tumor staging, tumor differentiation type and degree of lesion, intraoperative bleeding degree and lesion tissue adhesion (P <0.05). Logistic multivariate regression analysis showed that the extent of intraoperative bleeding, focal tissue adhesion, tumor stage, tumor differentiation type and degree of lesion were the influencing factors of laparoscopic gastrointestinal elective surgery laparotomy (P <0.05). Conclusion Laparoscopic gastrointestinal surgery laparotomy complicated by factors that affect the operation in the surgical procedure should be strictly controlled, a clear indications, combined with the patient's own surgical risk and the actual condition of the appropriate treatment, the conversion rate to a minimum laparotomy.