腹腔镜胆囊切除术中转开腹的原因探讨和对策

The cause and strategy of opening cholecystectomy transferred from laparoscopic cholecystectomy.

目的探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）中转开腹的原因及对策。方法对我院2002年4月～2008年4月783例LC术中转开腹41例的临床资料进行回顾性分析。结果LC中转开腹手术率为5.2%。中转开腹的主要原因为解剖结构不清和副损伤,分别占43.9%（18/41）和39.0%（16/41）;前3年LC术中转开腹率明显高于后3年（P〈0.05）;前3年因副损伤而中转开腹的比例明显高于后3年（P〈0.05）。结论解剖结构不清是LC术中转开腹的主要原因,LC术开展初期技术不熟练导致副损伤也是中转开腹的重要原因,严格把握LC手术指征,提高操作技术是降低中转开腹的关键。

Objective To investigate the cause and strategy of opening cholecystectomy transferred from laparoscopic cholecystectomy.Methods 41 cases with open cholecystectomy in laparoscopic cholecystectomy were anzlyzed retrospectively from April 2002 to April 2008.Results The operability of opening cholecystectomy in laparoscopic cholecystectomy was 5.2%.anatomic structure wasn＇t clear,and vice damage was the main reason of opeing cholecystectomy in laparoscopic cholecystectomy,account for 43.9%（18/41） and 39.0%（16/41）respectively.The operability of opening cholecystectomy in laparoscopic cholecystectomy during the first 3 years was higher than its＇ during the behind 3 years,P〈0.05.the proportion of opening cholecystectomy due to vice damage in laparoscopic cholecystectomy during the first 3 years was higher than its＇ during the behind 3 years,P〈0.05.Conclusion Anatomic structure wasn＇t clear,and vice damage was the main reason of opening cholecystectomy in laparoscopic cholecystectomy.Strict grasp operative indication,and boost operative technique is the key point of lowering operability of opening cholecystectomy in laparoscopic cholecystectomy.