腹腔镜胆囊切除术转开腹胆囊切除术45例原因与体会

THE REASONS AND EXPERIENCE OF 45 TAPAROSCOPIC CHOLECYSTECTOMY CONRERTED TO OPEN CHOLECYSTECTOMY

本文对４５例腹腔镇胆囊切除术中转开腹胆囊切除术原因进行了分析。中转原因通常与炎症和解剖关系不清有关，而并发症常是经验不足及在困难和和无把握情况下勉强从事的结果。前９个月中行腹腔镜胆囊切除术１７９例，中转开腹胆囊切除术１９例，其中主动中转１１例，被迫中转４例。再手术４例，１例死亡。后９个月中行腹腔镜胆囊切除术１１７例，中转开腹胆囊切除术２６例，其中主动中转２２例，被迫中转３例，再手术１例。前后比较二者差异显著．表明开放手术中转率有助于提高腹腔镜胆囊切除术的安全性和优良率。

he reasons of 45 patients first undergoing laparoscopic cholecystectomy and then convertedto open cholecystectomy were reyiewed during a recent 18-month period.the reasons for theconversion were generally related to inflammation,difficult dissection or unclear anatomicdefinition.Complicrtions usually resulted form inexperience and forced operation in the difficultand unassured circumstances.In the first early 9 months,19 of 179 patients were converted to opensurgecy(11 were active conversion.4 forced convemon and 4 reoperation).In the subsequent 9months,26 of 117 pattents were converted to open sureery(22 were active co nversion,3 forcedconversion and 1 reopetation).There was significant difference in the safety and fine rate for thelatter versus the former.It can be cuncluded that open conversion rate did help to improve safety and fine rate of laparoscopic cholecystectomy.