急性胆囊炎行腹腔镜胆囊切除术致中转开腹的危险因素

Risk factors of laparoscopic cholecystectomy to open cholecystectomy in acute cholecystitis.

目的评估急性胆囊炎时行腹腔镜胆囊切除中转为开腹胆囊切除的危险因素。方法回顾分析笔者所在医院2001年～2008年急性胆囊炎行LC手术的病例，选择症状出现1周以内，且在入院后72h行LC的患者，排除有严重并发症的患者。分析其年龄、白细胞计数、胆囊壁厚度、炎症程度及腹部手术史与中转开腹手术的关系。结果308例合适病例中，中转开腹手术的患者37例，炎症致胆囊三角解剖不清是主要原因，占43．2％。年龄大于65岁、白细胞计数大于15000／mm^3。胆囊壁厚度大于4mm、复杂炎症以及上腹部手术史是导致中转的危险因素。结论急性胆囊炎时行LC是可行的，术前评估中转的风险有助于选择合适的患者行LC，减少并发症。

Objective To evaluate various properative risk factors predicting the conversion of laparoseopic choleeystectomy to open choleeystectomy in acute cholecystitis. Methods Retrospectively analyze the patients with acute choleeystitis who admitted laparoseopic ehole- cysteetomy in our hospital between in 2001 - 2008. All Patients were subjected to laparoscopic cholecystectomy within 72 hours of admission but within a week of onset of symptoms, patients with uncontrolled cardiovascular disease were excluded from the study, the data of age,WBCs count, type of acute cholecystitis and history of abdominal surgery were analyzed. Results Among the 308 patients formed the cohort of this study,37 converted to open cholecystectomy. Disturbed anatomy in the region of calots triangle was the most common cause of conversion observed in 43. 2%. Age more than 65 years,leucocyte count more than 15 000/mm^3 , gallbladder wall thickness of more than 4mm on ultrasonography, complicated disease and history of upper abdominal surgery were determinant for open procedure. Conclusion Laparoscopic cholecystectomy can be performed safely in acute cholecystitis. To evaluate preoperative risk factors is helpful in selecting patient to perform LC and can avoid dangerous attempt,reducing complications of LC in acute eholecystitis.