腹腔镜胆囊切除术中转开腹31例临床分析

Conversion to open surgery during laparoscopic cholecystectomy：A report of 31 cases

目的总结腹腔镜胆囊切除术（1aparoscopic cholecystectomy，LC）中转开腹的原因。方法回顾分析我院1999年1月至2008年12月间中转开腹31例患者的临床特点及治疗效果。结果右肝管损伤1例，肝总管损伤1例，胆总管损伤2例，经开腹置T管引流后治愈，迷走胆管漏1例，经开腹结扎并置管引流后治愈。胆囊三角处理困难或因出血致术野不清23例，十二指肠损伤2例，机器故障1例。予中转开腹进一步处理，除1例十二指肠损伤死亡外，其余均痊愈出院。结论胆囊三角处理困难及术中出血是中转开腹的主要原因，熟悉各种解剖变异、规范精细操作、适时中转开腹是预防LC严重并发症的关键。

Objective To examine the causes for conversion to open surgery during laparo- scopic cholecystectomy （LC） in order to avoid the development of severe complications and hence passive laparotomy. Methods Clinical features and efficacy of 31 patients who were converted to open surgery during LC in our hospital between January 1999 and December 2008 were retrospectively analyzed. Re- suits The causes for conversion to open surgery included right hepatic duct injury in 1 case,common he- patic duct injury in 1 case,bile duct injury in 2,which were cured after T -tube drainage,aberrant bile duct leakage in one which was recovered by ligation and catheter drainage. There were 23 patients in whom difficult management encountered with gallbladder triangle and hemorrhage resulted in ambiguous operative field. Duodenal injury occurred in 2 and intraoperative machine failure in 1. One patient died of duodenal injury,and the rest was cured. Conclusion Difficult management in gallbladder triangle area and intraoperative hemorrhage are the main reason for conversion to open surgery during LC. Familiarity with a variety of anatomical variation, standard and precise surgical skills and timely laparotomy are the key to preventing serious complications during LC.