| Laparoscopic cholecystectomy (LC) has become the primary operative procedure for benign diseases of gallbladder because of its minial trauma ,slight pain and minal scar;but some LC cases need convert to open cholecystectomy. Establishing a scoring system that predicts the probability of laparoscopic cholecystectomy conversion to open cholecystectomy,and evaluating operative difficulty of LC and the probability of laparoscopic cholecystectomy conversion to open cholecystectomy, surgeons with different laparoscopy experience can choose cases with different degrees of difficulty,and the patients or their families couid be told the probability of conversion that enforce the commention between the doctors and patients;the cases with high scores should convert to open in time in order to avoid sever complications;the hospital can perform out-patient surgery or day-surgery for the LC cases with lower scores and the basal hospital can select cases with lower scores for LC. There is not civil report comprehensively evaluating the difficulty of LC and probability of conversion,and there few articles having established the mathemetical models that predicts LC conversion to open based on clincal parameters.But it had not been involved that these models had been utilized for newLC cases.This article will research on how to establish the mathematical model predicting LC converts to open, how to evaluate the preoperative risk factors of LC conversion to open , how to evaluate the efficiency of this scoring systems,and utilization in clinc.Clincal data and methods7134 LC cases had been performed from 4/4/1994 to 6/30/2001 in Sir Run Run Shaw Hospital ,410 cases of which had converted to open(5. 81%). Preoperative data of successful series and conversion series were compared (chi-square text),and risk factors of LC were selected .then multivariable analyse with Logistic regression was used for these risk factors for further selection. Each risk factor was given a score acording to the its coefficient of the mathematical function that was established with Logistic regression analyse. Every case have a score and all the cases can be divided to groups based on their scores. The conversion rate of each group were compared. Calculating the pair of sensitivity and specificity of each score that predicts LC conversion to open, drawing the ROC (Receive-operator characteristic) curve, and calculating the area below ROC curve which evalvates the efficiency of the scoring system. Selecting a score as the cut-off point of the curve which made the pair of sensitivity and specificity the most ideal. Deviding all the 938 LC cases performed from 7/1/2001 to 12/31/2001 to groups based the scoreing system,and comparing the converion rate of all the groups. SPSS version 10.0 for Windows software and Microsoft Excel 2000 were used in statistical analyses.ResultsAnivariable analyze showed: male, >=65,upper abdominal operation history, diabetes, high lever of total bilirubin ( >= 1.2mg/dl) , thickened wall of gallbl adder (>=4cm), dilated diameter of common bile duct ( >= 8cm),and acute cholecystitis are risk factors.The function of probability that LC converts to open cholecystectomy:P=ey/(1+ey)y=-4.481+0.383×sex* + 1.370×age+2.350×(upper-abdomial-operation-hist ory)+1.235×diabetes+1.128×(total-bilirubin)+0.704×(gallbladder-wall)+2.69 3×(diameter-of common-bile-duct) +1.887×(acute-cholecystitis)*:risk factor=l, no risk factor=0According to the coefficients of the function, each risk factor was given a score:sex (male 4, female 0), age (>=6514, <650), upper abdominal operation history (yes 24,not 0), diabetes (yes 12, not 0), total biliburin (>= 1. 2mg/dl 11,...
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