多次上腹部手术患者腹腔镜胆囊切除术的可行性研究

Clinical study of laparoscopic cholecystectomy in patients with histories of multiple upper abdominal surgeries

目的:探讨多次(≥2次)上腹部手术患者腹腔镜胆囊切除术(LC)的可行性和手术特点。方法:连续观察21例有多次上腹部手术史的LC患者,对治疗结果进行回顾性分析。结果:LC成功13例,成功率为61.9%。2次上腹手术后患者LC成功率为66.7%,3次者为33.3%。8例中转剖腹手术,中转率为38.1%,平均手术时间为72.1min,明显高于同期无上腹部手术史的患者。LC完成及中转剖腹手术患者均无相关手术并发症发生。结论:多次上腹手术史不应成为LC的禁忌证,但其手术难度加大,中转剖腹率增高,手术时间延长,对手术医师的技术要求较高。

Objective: To evaluate the feasibility and character of laparoscopic cholecystectomy (LC) in patients with histories of multiple upper abdominal surgeries(≥2 ). Methods: We retrospectively analyzed the results of 21 LC operations in patients who had previously accepted two or three upper abdominal surgeries . Results: LC were successfully performed in 13 of all the patients (61.9%). The success rate of LC in patients with 2 upper abdominal surgeries was 66.7%. It was only 33.3% in patients with 3 upper abdominal surgeries. Eight of the patients (38.1%) were transformed to open cholecystectomies. The mean operation time was 72.1 minutes. The transform rate was higher, and the mean operation time was longer than those without previous upper abdominal surgery at the same period in our department. Conclusion: History of multiple upper abdominal surgeries should not be regarded as the contraindication to laparoscopic cholecystectomy. But these operations were difficult with higher transform rate and longer operation time.