Establishment And Application Of Scoring Standard Predicting The Difficulty Of A Laparoscopic Cholecystectomy

Objective Establishing a scoring standard and using it to predict the difficulty of the laparoscopic cholecystectomy based on preoperative and intraoperative clinical datas. Then we evaluated reliability of the scoring standard.Methods First study stage (Establishment of the scoring standard) Anivariable analysis was performed for the preoperative and intraoperative clinical datas of the 1500 patients undergoing LC in our hospital from 12/25/2003 to 10/13/2005, we selected the risk factors associated with difficult LC, Then multivariable analysis with logistic regression was performed for the selected risk factors and given scores. Thus we stablish the scoring standard through these datas.The second study stage(Evaluation of the scoring standard) we evaluated reliability of the standard by predicting difficulty of 231 consecutive patients receive LC in our hospital from 12/1/2005 to 4/1/2006 compare with the real situation of each operation. Result First study stage , Through anivariable analysis we found acute cholecystitis, high level of total bilirubin( ≥ 17. lumol/L), thickened wall of gallbladder (≥4mm), atrophic cholecystitis , impacted stone in gallbladder, cystic inflammation and compacted conglutination of Calot triangle were risk factors and we stablished the scoring standard through these datas. The second study stage, when the reliability of our standard was examined in a second study in 231 consecutive patients undergoing LC in our hospital from 12/1/2005 to 4/1/2006, we found 80% of the patients were predicted correctly.