Risk Factors For Open Conversion In Patients Undergoing Laparoscopic Cholecystectomy Combined With Common Bile Duct Exploration And Relevant Clinical Analysis

Objective:To determine the risk factors for conversion to open surgery in patients undergoing laparoscopic cholecystectomy(LC)combined with laparoscopic common bile duct exploration(LCBDE)in treatment of gallbladder stones with common bile duct stones and perform the relevant clinical analysis.Methods:The clinical data of 197 patients undergoing LC plus LCBDE from January 2014 to June 2018 were retrospectively analyzed.The risk factors for conversion to open surgery were screened,and the perioperative variables and postoperative complications between patients undergoing completed laparoscopic surgery and those converted to open surgery were compared.Results:Fifteen cases(7.6%)of the 197 patients were converted to open surgery.Univariate and multivariate analyses showed that serum total bilirubin>17.1 ?mol/L(OR=5.156,P=0.032),gallbladder wall thickness>6 mm(OR=7.971,P=0.012),jaundice(OR=10.715,P=0.002)and stone incarceration in the lower part of the common bile duct(OR=20.203,P=0.003)were independent risk factors for open conversion.For predicting open conversion,the regression equation established by integration of the above 4 factors showed an area under ROC of 0.891,with a sensibility of 80.0% and specificity of 98.9%.In patients undergoing completed laparoscopic surgery compared with those undergoing open conversion,the operative time,intraoperative blood loss,number of postoperative analgesic use,time period of postoperative antibiotic use,time to first postoperative anal gas passage,length of hospital stay,hospitalization cost and incidence of complications were significantly reduced(all P<0.05).Conclusion:For patients undergoing LC plus LCBDE,the above 4 independent risk factors should be carefully evaluated,which has important significance for optimal preoperative preparation,operative procedure selection,reducing open conversion rate and improvement of the patient outcomes.