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中华肝脏外科手术学电子杂志 ›› 2024, Vol. 13 ›› Issue (02) : 169 -175. doi: 10.3877/cma.j.issn.2095-3232.2024.02.009

临床研究

腹腔镜胆囊切除术难度评分系统在急性胆囊炎治疗中的应用价值
孟塬1, 巴合提·卡力甫1, 马志刚1, 王锦国1, 张杰1, 李玉鹏1, 宋巍1, 田广磊1, 陈雄1,()   
  1. 1. 830001 乌鲁木齐,新疆维吾尔自治区人民医院肝胆外科
  • 收稿日期:2024-01-02 出版日期:2024-04-10
  • 通信作者: 陈雄
  • 基金资助:
    新疆维吾尔自治区区域协同创新专项——科技援疆计划项目(2022E02133)

Application values of difficulty scoring system of laparoscopic cholecystectomy for acute cholecystitis

Yuan Meng1, Kalifu Baheti·1, Zhigang Ma1, Jinguo Wang1, Jie Zhang1, Yupeng Li1, Wei Song1, Guanglei Tian1, Xiong Chen1,()   

  1. 1. Department of Hepatobiliary Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China
  • Received:2024-01-02 Published:2024-04-10
  • Corresponding author: Xiong Chen
引用本文:

孟塬, 巴合提·卡力甫, 马志刚, 王锦国, 张杰, 李玉鹏, 宋巍, 田广磊, 陈雄. 腹腔镜胆囊切除术难度评分系统在急性胆囊炎治疗中的应用价值[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(02): 169-175.

Yuan Meng, Kalifu Baheti·, Zhigang Ma, Jinguo Wang, Jie Zhang, Yupeng Li, Wei Song, Guanglei Tian, Xiong Chen. Application values of difficulty scoring system of laparoscopic cholecystectomy for acute cholecystitis[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(02): 169-175.

目的

探讨腹腔镜胆囊切除术难度评分系统(DiLCs)在急性胆囊炎腹腔镜胆囊切除术(LC)治疗中的应用价值。

方法

回顾性分析2016年5月至2019年1月在新疆维吾尔自治区人民医院行LC的158例急性胆囊炎患者临床资料。其中男88例,女70例;平均年龄(60±18)岁。患者均签署知情同意书,符合医学伦理学规定。分别采用DiLCs评分系统和急性胆囊炎京东指南2018(TG18)分级系统对患者围手术期指标进行分析,两个分级系统与临床指标相关性分析采用单因素方差分析、秩和检验等;采用ROC曲线下面积(AUC)对两个系统进行比较。

结果

随着两种评分系统评分增加,WBC、手术时间、术中出血量、住院时间、胆囊造瘘率、中转开腹率等急性胆囊炎相关指标增加,差异有统计学意义(P<0.05)。TG18和DiLCs评估并发症的AUC分别为0.889(95%CI:0.829~0.933)和0.509(95%CI:0.428~0.598),TG18明显优于DiLCs(Z=3.795,P<0.05)。DiLCs和TG评估中转开腹率的AUC分别为0.697(95%CI:0.619~0.768)和0.746(95%CI:0.670~0.811),差异无统计学意义(Z=0.829,P>0.05)。DiLCs和TG评估胆囊造瘘率的AUC分别为0.664(95%CI:0.584~0.737)和0.770(95%CI:0.697~0.833),差异无统计学意义(Z=1.639,P>0.05)。

结论

DiLCs可有效评估患者手术难度和治疗方式选择,其评估能力与TG18一致,而在手术风险预测等方面弱于TG18。

Objective

To evaluate the operative difficulty scoring system of laparoscopic cholecystectomy (DiLCs) for acute cholecystitis.

Methods

Clinical data of 158 patients with acute cholecystitis who underwent LC in People's Hospital of Xinjiang Uygur Autonomous Region from May 2016 to January 2019 were retrospectively analyzed. Among them, 88 patients were male and 70 female, aged (60±18) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. DiLCs scoring system and Tokyo Guidelines 2018 (TG18) for acute cholecystitis were adopted to analyze the perioperative indexes of patients. The correlation between two grading systems and clinical indexes was analyzed by single-factor analysis of variance (ANOVA) and rank-sum test. The area under ROC curve (AUC) was employed to compare two scoring systems.

Results

With the increase of the scores of two scoring systems, WBC, operation time, intraoperative blood loss, length of hospital stay, gallbladder fistula rate, conversion rate to open surgery and other indexes related to acute cholecystitis were also increased, and the differences were statistically significant (P<0.05). The AUC of TG18 and DiLCs in evaluating complications was 0.889 (95%CI: 0.829-0.933) and 0.509 (95%CI: 0.428-0.598), and the AUC of TG18 was significantly higher compared with that of DiLCs (Z=3.795, P<0.05). The AUC of DiLCs and TG in evaluating conversion rate to open surgery was 0.697 (95%CI: 0.619-0.768) and 0.746 (95%CI: 0.670-0.811), and the difference was not statistically significant (Z=0.829, P>0.05). The AUC of DiLCs and TG in evaluating gallbladder fistula rate was 0.664 (95%CI: 0.584-0.737) and 0.770 (95%CI: 0.697-0.833), and the difference was not statistically significant (Z=1.639, P>0.05).

Conclusions

DiLCs can effectively evaluate the difficulty of LC and the selection of therapeutic options. The evaluation capability of DiLCs is consistent with that of TG18, while weaker in predicting surgical risk.

表1 TG18急性胆囊炎严重程度分级[6]
表2 急性胆囊炎手术难度预测评分(DiLCs)[7]
表3 TG18不同分级急性胆囊炎患者基线特征、手术情况比较
表4 DiLCs不同分组急性胆囊炎患者基线特征、手术情况比较
指标 0分组 1~4分组 5~9分组 ≥10分组 统计值 P
性别(例)         χ2=0.417 0.937
22 18 30 18    
20 12 24 14    
年龄(岁,±s 55±19 62±17 55±18 51±15 F=1.866 0.138
CCI [MQ1Q3)] 1.0(0,5.0) 3.0(3.0,4.0) 3.0(2.0,4.0) 4.0(0,7.0) H=4.433 0.218
并发症(例)         - 0.096
36 29 43 30    
6 1 11 2    
收缩压[mmHg,MQ1Q3)] 139(117,151) 117(115,138)a 136(124,140) 114(114,132)ac H=18.541 <0.001
心率[次/分钟,MQ1Q3)] 74(68,78) 86(79,90)a 78(72,79)b 119(73,120)ac H=34.046 <0.001
WBC [×109/L,MQ1Q3)] 6.3(6.1,7.1) 7.3(7.2,9.6) 10.6(9.5,14.9)ab 16(15.6,19.1)ab H=73.705 <0.001
中性粒细胞计数[×109/L,MQ1Q3)] 3.9(3.7,4.7) 5.4(4.3,7.7) 9.8(7.1,10.9)ab 14.1(11.6,14.1)ab H=58.847 <0.001
纤维蛋白原[g/L,MQ1Q3)] 3.6(2.8,4.0) 3.2(2.8,3.2) 5.3(3.2,5.6)ab 6.0(6.0,6.0)ab H=66.518 <0.001
ALP [U/L,MQ1Q3)] 80(61,84) 80(64,99) 80(67,83) 200(151,266)abc H=58.976 <0.001
中转开腹(例)         - 0.001
42 30 45 27    
0 0 9ab 5ab    
胆囊造瘘(例)         - <0.001
42 28 46 22    
0 2a 8a 10abc    
术中出血量[ml,MQ1Q3)] 5(5,5) 43(10,50)a 20(5,100)a 100(50,250)abc H=68.964 <0.001
手术时间[min,MQ1Q3)] 55 (35,82) 120 (45,125)a 90(70,120)a 90(90,186)a H=27.890 <0.001
住院时间[d,MQ1Q3)] 5(4,10) 8 (6,8) 11 (5,13)ab 10(8,11)ab H=28.026 <0.001
图1 DiLCs和TG18评估急性胆囊炎腹腔镜胆囊切除术患者指标ROC曲线注:a、b、c分别为术后并发症发生率、中转开腹率、胆囊造瘘率比较;TG18为急性胆囊炎京东指南2018,DiLCs为腹腔镜胆囊切除术难度评分
[1]
Shafi S, Aboutanos M, Brown CV, et al. Measuring anatomic severity of disease in emergency general surgery[J]. J Trauma Acute Care Surg, 2014, 76(3):884-887.
[2]
Kohga A, Suzuki K, Okumura T, et al. Outcomes of early versus delayed laparoscopic cholecystectomy for acute cholecystitis performed at a single institution[J]. Asian J Endosc Surg, 2019, 12(1):74-80.
[3]
Cao AM, Eslick GD, Cox MR. Early cholecystectomy is superior to delayed cholecystectomy for acute cholecystitis: a meta-analysis[J].J Gastrointest Surg, 2015, 19(5):848-857.
[4]
Borzellino G, Sauerland S, Minicozzi AM, et al. Laparoscopic cholecystectomy for severe acute cholecystitis. a meta-analysis of results[J]. Surg Endosc, 2008, 22(1):8-15.
[5]
Kimura Y, Takada T, Kawarada Y, et al. Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo guidelines[J]. J Hepatobiliary Pancreat Surg, 2007, 14(1):15-26.
[6]
Okamoto K, Suzuki K, Takada T, et al. Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis[J]. J Hepatobiliary Pancreat Sci, 2018, 25(1):55-72.
[7]
Bourgouin S, Mancini J, Monchal T, et al. How to predict difficult laparoscopic cholecystectomy? proposal for a simple preoperative scoring system[J]. Am J Surg, 2016, 212(5):873-881.
[8]
Schol FP, Go PM, Gouma DJ, et al. Laparoscopic cholecystectomy in a surgical training programme[J]. Eur J Surg, 1996, 162(3):193-197.
[9]
Morales-Maza J, Rodríguez-Quintero JH, Santes O, et al. Conversion from laparoscopic to open cholecystectomy: risk factor analysis based on clinical, laboratory, and ultrasound parameters[J]. Rev Gastroenterol Mex, 2021, 86(4):363-369.
[10]
Tufo A, Pisano M, Ansaloni L, et al. Risk prediction in acute calculous cholecystitis: a systematic review and meta-analysis of prognostic factors and predictive models[J]. J Laparoendosc Adv Surg Tech A, 2021, 31(1):41-53.
[11]
Wani H, Meher S, Srinivasulu U, et al. Laparoscopic cholecystectomy for acute cholecystitis: any time is a good time[J]. Ann Hepatobiliary Pancreat Surg, 2023, 27(3):271-276.
[12]
Takada T, Kawarada Y, Nimura Y, et al. Background: Tokyo Guidelines for the management of acute cholangitis and cholecystitis[J]. J Hepatobiliary Pancreat Surg, 2007, 14(1):1-10.
[13]
Takada T, Strasberg SM, Solomkin JS, et al. TG13: updated Tokyo Guidelines for the management of acute cholangitis and cholecystitis[J]. J Hepatobiliary Pancreat Sci, 2013, 20(1):1-7.
[14]
Vaccari S, Cervellera M, Lauro A, et al. Laparoscopic cholecystectomy: which predicting factors of conversion? two Italian center's studies[J]. Minerva Chir, 2020, 75(3):141-152.
[15]
Lal P, Agarwal PN, Malik VK, et al. A difficult laparoscopic cholecystectomy that requires conversion to open procedure can be predicted by preoperative ultrasonography[J]. JSLS, 2002, 6(1):59-63.
[16]
Ramakrishna HK. Predictive factors for conversion of laparoscopic cholecystectomy[J]. Indian J Surg, 2013, 75(2):152.
[17]
Livingston EH, Rege RV. A nationwide study of conversion from laparoscopic to open cholecystectomy[J]. Am J Surg, 2004, 188(3):205-211.
[18]
Kanakala V, Borowski DW, Pellen MGC, et al. Risk factors in laparoscopic cholecystectomy: a multivariate analysis[J]. Int J Surg, 2011, 9(4):318-323.
[19]
Asai K, Watanabe M, Kusachi S, et al. Risk factors for conversion of laparoscopic cholecystectomy to open surgery associated with the severity characteristics according to the Tokyo guidelines[J]. Surg Today, 2014, 44(12):2300-2304.
[20]
Warchałowski Ł, Łuszczki E, Bartosiewicz A, et al. The analysis of risk factors in the conversion from laparoscopic to open cholecystectomy[J]. Int J Environ Res Public Health, 2020, 17(20):7571.
[21]
Dimou FM, Adhikari D, Mehta HB, et al. Outcomes in older patients with gradeⅢ cholecystitis and cholecystostomy tube placement: a propensity score analysis[J]. J Am Coll Surg, 2017, 224(4):502-511, e1.
[22]
Medina VJ, Martial AM, Chatterjee T. Asymptomatic gangrenous acute cholecystitis: a life-threatening condition[J]. Cureus, 2023, 15(3):e36672.
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