Risk Factors And Prevention Of Severe Complications After Laparoscopic Cholecystectomy

Object Study on the possible influence of laparoscopic cholecystectomy(Laparoscopic cholecystectomy LC)risk factors for postoperative complications.Methods 2000 cases of laparoscopic cholecystectomy in the Department of general surgery of Huainan F irst People's Hospital from January 2012 to July 2016 were collected.O f the 2000 patients,722 were males and1278 females with a median age of 46 years,ranging from 17 to 88 years.Including chronic cholecystitis with cholecystolithiasis in 1479 cases(73.9%);gallbladder polyps in 269 cases(13.5%);60 cases of gallbladder calculi complicated with polyps(3%);acute cholecystitis with cholelithiasis in 157 cases(7.9%);15(0.8%)cases of gallbladder adenoma,14 cases of gallbladder adenomyomatosis(0.7%);4 cases of chronic non gallstone(0.20%);2 cases of gallbladder carcinoma(0.1%).The study collected the general information,preopreative examination,operation data and postoperative data of thesepatients,and select 12 risk factors which may related to the complications after LC(age,gender,history of abdominal surgery,course of disease,liver function,surgical experience,intraoperative blood loss,there is no gallbladder triangle variation,gallbladder neck calculi Calot triangle adhesion severity,thickness of gallbladder wall,with acute inflammation).Statistical method :all data in the study analyzed by SPSS 22.0 statistical software,measurement data use t-test and enumeration data use chi‘square test,multivariate analysis use Logistic regression analysis.Difference is statistically significant if P<0.05.Result Of the 2000 patients who received LC,the incidence of postoperative complications was 5.15%(n=103).The incidence of bile leakage was 1.85%(n=37),and the incidence rate of abdominal bleeding was(n=24).The incidence rate of bile duct injury was 0.70%(n=14),and the incidence rate of gastrointestinal injury was(n=17).The incidence o f other complications was 0.85%(n=17).Univariate analysis shows the history of abdominal surgery,the experience of the surgeon,the variation of the gallbladder triangle and the acute inflammation were the significant risk factors for the morbidity(P<0.05).There were no significant differences in the incidence of postoperative complications in different age,gender,course of disease,gallbladder neck stones,gallbladder wall thickness,Calot triangle adhesion,intraoperative blood loss,liver function.Acute cholecystitis and the experience of the surgeon were the significant risks for postoperation bleeding.The acute cholecystitis,the variation of the gallbladder triangle and the experience of the surgeon were the significant risks for bile duct injury and bile leakage.The history of abdominal surgery,acute cholecystitis,and surgical experience are risk factors for postoperative gastrointestinal injury..Multivariate analysis shows,The experience of the surgeon,variation of the gallbladder triangle and acute inflammation were independent risk factors for postoperative complications.The risk factors for postoperative bleeding were acute cholecystitis and the experience of the surgeon.Variation of gallbladder triangle and acute inflammation are independent risk factors for postoperative bile leakage and bile duct injury.The surgeon's experience is an independent risk factor for postoperative organ damage(P<0.05)Conclusion Laparoscopic cholecystectomy(LC)is still a complex operation with certain risks.The incidence of postoperative complications was closely related to the factors such as the history of abdominal surgery,acute cholecystitis,gallbladder triangle variation,and surgeon's experience.Once the postoperative complications,as long as the positive and effective treatment measures,LC is safe and feasible.