Abstract: Objective　Meta-analysis was used to construct a risk model for predicting conversion to open surgery in laparoscopic cholecystectomy（LC）．Methods　The Cochrane Library，PubMed，EMBase，Wanfang Data Knowledge Service Platform，VIP Network and CNKI databases were searched and both nationally and internationally published articles involving conversion to open surgery in LC up to May 2017 were retrieved.The overall risk of conversion to open surgery in LC was calculated by Meta-analysis.The corresponding risk prediction model was established based on natural log（ln） transformation of the overall risk.Results　A total of 25 articles and 34 112 patients were included.Meta-analysis showed that the following variables were significantly different between the conversion group and non-conversion group：sex（male），age（advanced age），history of upper abdominal surgery，time of onset of cholecystitis greater than 72 h，history of cholecystitis，diabetes complications，body mass index（BMI）≥25 kg/m2，gallbladder wall thickening，cholecystolithiasis incarceration，high white blood cell count before surgery，and high level of total bilirubin before surgery，these were the risk factors for conversion to open surgery in LC（OR>1.00，P<0.05）．These 11 risk factors were included in the Logistic prediction model which was expressed as Logit（P）=α+0.49X1+0.80X2+1.31X3+1.42X4+1.41X5+0.75X6+0.46X7+1.52X8+0.87X9+1.16X10+1.04X11.X1，X2，…，X11 expressed as　sex（male），age（advanced age），history of upper abdominal surgery，time of onset of cholecystitis greater than 72 h，history of cholecystitis，diabetes complications，BMI≥25 kg/m2，gallbladder wall thickening，cholecystolithiasis incarceration，high white blood cell count before surgery，and high level of total bilirubin before surgery.Conclusion　Based on Meta-analysis，a Logistic risk prediction model for conversion to open surgery in LC was established.This model can be used to predict the risk of conversion to open surgery in LC.

Key words: Cholecystectomy, laparoscopic；Laparotomy；Meta-analysis；Logistic models；Risk prediction

摘要： 目的　采用Meta分析方法构建腹腔镜胆囊切除术（LC）中转开腹风险预测模型。方法　计算机检索Cochrane Library、PubMed、EMBase、万方数据知识服务平台、维普网和中国知网等数据库，检索时间为建库至2017年5月，检索国内外公开发表的关于LC中转开腹危险因素的文献。采用Meta分析计算LC中转开腹危险因素的综合危险度，以综合危险度的自然对数转换值为基础建立对应的风险预测模型。结果　共纳入25篇文献，34 112例患者。Meta分析结果显示，两组男性、高龄、上腹部手术史、胆囊炎发作时间≥72 h、胆囊炎发作史、合并糖尿病、体质指数（BMI）≥25 kg/m2、胆囊壁增厚、胆囊结石嵌顿、术前白细胞计数较高、术前总胆红素水平较高所占比例比较，差异均有统计学意义（OR>1.00，P<0.05），均为LC中转开腹的危险因素。最终共11个危险因素被纳入Logistic风险预测模型。所构建的Logistic风险预测模型为：Logit（P）=α+0.49X1+0.80X2+1.31X3+1.42X4+1.41X5+0.75X6+0.46X7
+1.52X8+0.87X9+1.16X10+1.04X11。预测模型中，X1、X2、…、X11分别代表男性、高龄、上腹部手术史、胆囊炎发作时间≥72 h、胆囊炎发作史、合并糖尿病、BMI≥25 kg/m2、胆囊壁增厚、胆囊结石嵌顿、术前白细胞计数较高、术前总胆红素水平较高。结论　以Meta分析结果为基础建立了具有循证基础的LC中转开腹Logistic风险预测模型，该模型可用于LC中转开腹风险的预测。

关键词: 胆囊切除术, 腹腔镜；剖腹术；Meta分析；Logistic模型；风险预测