Abstract: ［Abstract］ Objective To investigate the role of the systemic inflammatory response and local anatomy in reducing the conversion rate during the approach of laparoscopic cholecystectomy. Methods A total of 892 patients admitted to our hospital between February 2005 and February 2015 were analyzed retrospectively. All their cholecystitis onset were smaller than 72 hours and all of them underwent surgery. The patients were divided into two group according to the time when the approach of laparoscopic cholecystectomy， and the role of the systemic inflammatory response and local anatomical factors affecting the conversion of laparoscopic cholecystectomy were discussed. Results All 892 patients underwent surgery without any intraoperative or postoperative deaths. There were no significant differences in age， gender and body mass index between groups A and B（P>0.05）. The difference of probability of conversion was significantly in the aspect of factors including fever（≥38.5℃）， peritonitis， white blood cell（WBC≥18.0×109/L）， C-reactive protein （CRP≥30.0 mg/L） and gallbladder wall thickness（≥0.8 cm） （P<0.05）. Conclusion The assessment of fever， peritonitis， WBC， CRP and the local anatomical of gallbladder can effectively reduce the rate of conversion.

Key words: conversion, laparoscopic cholecystectomy, scoring system, prediction

摘要： ［摘要］ 目的 探讨以全身炎症反应及影像学作评分系统在降低腹腔镜胆囊切除术中转开腹率的可行性。方法 回顾性分析我院2009年2月~2015年2月所收治发病时间≤72 h的急性结石性胆囊炎行手术治疗892例患者的临床资料，并以前后3年分成A、B两组，以全身炎症反应及影像学作系统评分，探讨预测性评分系统在腹腔镜胆囊切除术中对中转开腹率的影响。结果 892例患者均接受手术治疗，未出现术中、术后死亡病例。A、B两组患者在年龄、性别及体重指数上的组间差异均无统计学意义（P>0.05）。在892例患者中，体温≥38.5℃、腹膜炎体征、白细胞计数≥18.0×109/L、C-反应蛋白≥30.0 mg/L、胆囊壁厚度≥0.8 cm的组别有着更高的中转开腹率，组间差异均有显著的统计学意义（P<0.001）。以全身炎症反应及影像学作系统评分作术前评估，并以前后3年中转开腹率作对比，有显著差异（P<0.05）。结论 以全身炎症反应及影像学作系统评分作术前评估能有效降低中转开腹率。

关键词: 中转开腹, 腹腔镜胆囊切除术, 预测, 评分系统