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目的:探讨行腹腔镜胆囊切除术(LC)联合腹腔镜胆总管探查术(LCBDE)治疗胆囊结石合并胆总管结石时中转开腹的危险因素并进行相关临床分析.方法:回顾性分析2014年1月—2018年6月期间197例行LC+LCBDE患者的临床资料,筛选中转开腹手术的危险因素,并比较完成腹腔镜手术患者与中转开腹患者围术期指标及术后并发症情况.结果:197例中15例(7.6％)中转开腹.单因素与多因素回归分析结果显示,血清总胆红素＞17.1 μmol/L(OR=5.156, P=0.032 )、胆囊壁厚度 ＞6 mm (OR=7.971, P=0.012)、黄疸(OR=10.715,P=0.002)、胆总管下段结石嵌顿(OR=20.203, P=0.003 )是中转开腹的独立危险因素.以上4种因素组合所建立回归方程预测中转开腹的ROC曲线下面积为0.891,敏感度为80.0％,特异度为98.9％.与中转开腹患者比较,完成腹腔镜手术患者手术时间、术中出血量、术后镇痛剂使用次数、术后抗生素使用时间、术后肛门排气时间、住院时间、住院费用、并发症发生率均明显减少(均P＜0.05).结论:对于LC+LCBDE患者,应仔细评估上述4种独立危险因素,这对于完善术前准备、选择手术方式,降低开放手术转化率,以及改善患者预后具有重要意义.“,”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 μmol/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.