腹腔镜胆囊切除中转开腹手术原因分析

Cause analysis for conversions from laparoscopic to open cholecystectomy

目的:总结腹腔镜胆囊切除手术中转开腹手术原因。方法:对我科42例腹腔镜胆囊切除中转开腹的资料进行回顾性分析。结果:42例中转开腹的原因分别为炎症粘连、解剖不清、出血、内瘘、胆总管结石、胆管损伤、胃肠道损伤和肿瘤等。结论:术前重视评估及辅助检查,术中正确识别和处理胆囊管和胆囊动脉,冷静处理术中出血是减少胆管损伤及出血的重要措施,可以降低中转率。

Objective. To analyze the causes of the conversion from laparoscopic to open cholecystectomy. Methods： The clinical data of the 42 patients who received laparoscopic cholecystectomy during the last 12 years in our hospital was retrospectively analyzed. Results ： Among 42 cases, the main causes for the conversion from laparoscopic to open cholecystectomy were inflammatory adhesion, blurred anatomy, bleeding, fistula, common bile duct stones, bile duct injury, gastrointestinal injury, and carcinoma. Conclosion： Accurately identifying the abnormal cystic duck and cystic artery as well as controlling intraoperative bleeding are the important measures to reduce bile duct injury and bleeding. Adequate accessory examination and proper pre - operative evaluation are essential to decrease the rate of conversion.