腹腔镜胆囊切除术中转开腹临床分析

Clinical analysis of laparoscopic cholecystectomy laparotomy

目的探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的开腹指征及如何有效地把握主动开腹手术的时机,避免不必要的手术并发症,提高手术安全性。方法回顾性分析我院2000年9月至2005年7月553例LC手术资料。结果553例LC手术中,胆囊结石375例,胆囊息肉169例,结石伴息肉9例。在胆囊结石患者中,慢性萎缩性胆囊炎17例,胆囊颈管结石嵌顿5例。中转开腹手术12例(2.17%),均治愈出院。结论严格掌握开腹手术指征,适当放宽中转开腹指征,及时中转开腹,避免盲目自信是提高手术成功率的关键。

Objective To discuss the indication of open surgery during laparoscopic cholecystectomy and how to grasp the time LC being turned to OC effectually in order to avoid unnecessary complication and boost rates of safe operation.Methods From September 2000 to July 2005,there were 553 patients with gallbladder underwent LC. Their clinical data were retrospectively analyzed. Results Among all the cases, 375 cases were diagnosed as cholecystolithiasis and 169 cases were diagnosed as gallbladder polyps. 9 cases were diagnosed as cholecystolithiasis incorporated gallbladder polyps. In 375 cases of cholecystolithiasis, 17 cases had chronic atrophic cholecystitis and 5 eases were stone set in cystic duct or neck of gallbladder. The LC had converted to laparotomy in 2.17% of patients （12/553）. All cases had been cured and discharged. Conclusion In order to decrease complications, the indication of LC should be controlled strictly. When the situation is difficult,the LC should be converted to OC timely. The key to raise operation success rate is to avoid blind self-confidence.