腹腔镜胆囊切除术中转开腹46例报告

Report of 46 Cases of Laparoscopic Cholecystectomy with Secondary Laparotomy

目的探讨腹腔镜胆囊切除术(LC)中转开腹的原因、指针及处理技巧。方法对我院自2001年3月至2009年5月无选择性实施的2650例LC中转开腹手术的46例病例资料进行回顾性分析。结果 LC术中转开腹率为1.7%,其中胆总管损伤2例,右肝管损伤4例,术中出血8例,致密粘连\解剖不清30例,十二指肠损伤2例,经及时术中转开腹处理后,均痊愈出院,平均住院12 d。结论严格掌握手术指针,提高术者操作技巧,术前把握手术时机,术中预防胆管损伤、及时有效止血是降低LC中转开腹率的关键因素。

Objective To report the causes.indication and skills of during laparoscopic cholecystectomy （LC）. Methods The clinical data of 46 case of whith in 2650 cases of LC from March 2001 to may 2009 were retrospectively analyzed in our hospital. Result The total secondary laparotomy rate was 1.7%,there were 2 cases with common bile duct injury,4 cases with right hepatic duct injury,8 cases of intra-operative hemorrhage, 30 cases with severe adhesion of the gallbladder triangle resulting in an unclear anatomy,2 cases with duodenal injury. All above cases were recovered after secondary laparotomy treatment with median length of 12 days hospital stay. Conclusion Restricted operation indication, augmented operation technique, prevention of bile duct injury promptly and effectively stasis are the beyfactors in reducing secdondary laparotomy rate of LC.