腹腔镜下胆囊切除术中转开腹原因分析及其特点

Analysis on the causes and characteristics of the conversion to laparotomy in laparoscopic cholecystectomy

目的分析腹腔镜胆囊切除术中转开腹原因。方法分析和统计上海市嘉定区南翔医院和同济大学附属同济医院在2000年2月至2006年10月间110例LC中转开腹病例的临床资料。结果110例中转开腹病例中,胆囊三角处理困难60例(54.5%),术中出血12例(10.9%),胆囊与周围脏器严重粘连12例(10.9%),胆道损伤8例(7.3%),胆囊炎症严重6例(5.5%),胆总管结石5例(4.5%),腹腔严重粘连5例(4.5%),怀疑胆囊癌2例(1.8%)。结论胆囊三角处理困难仍是LC中转开腹的首要原因,术中出血和胆囊与周围脏器严重粘连及胆道损伤有较高的比例,胆总管结石和胆囊炎症严重相对较低。

Objective To analyze the causes of the conversion to laparotomy in laparoscopic cholecystectomy. Methods 110 cases of laparoscopic cholecystectomy converting to laparotomy in Nanxiang Hospital and Tongji Hospital from February,2000 to October,2006 were reviewed retrospectively. Results In the 110 cases of laparoscopic cholecystectomy converting to laparotomy, 60 cases （54.5%） had ditfficulties in dissecting the Calot＇s triangle; 12 cases （ 10.9% ） had bleeding during operation; 12 cases （10. 9% ） had severe adhesion between cholecystis and surrounding organs; 8 cases （7.3%） had injury of bile duct; 6 cases （5.5%） had severe cholecystitis; 5 cases （4.5%） had common duct stones; 5 cases （4.5%） had severe abdominal adhesion;2 cases （ 1.8% ） were suspected of carcinoma of gallbladder. Conclusion The major causes of the conversion to laparotomy in laparoscopic cholecystectomy are Calot＇s triangle＇s anatomy,bleeding, adhesion surrounding cholecystis and injury of bile duct. Common duct stones and cholecystitis dont take the major part.