腹腔镜胆囊切除术中转开腹的原因分析及时机选择

The reason for conversion to open surgery and the opportunity selection of laparoscopic cholecystectomy

目的:研究腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中转开腹的原因及时机。方法:将成功施行LC的胆囊炎合并胆囊结石患者归入LC组,中转行开腹胆囊切除术(open cholecystectomy,OC)的患者归入OC组,进一步根据中转开腹的时机分为主动中转组与被动中转组,以观察LC中转开腹的危险因素及术中、术后各项指标。结果:OC组上腹部手术史例数、急性胆囊炎发作例数、白细胞计数、胆囊壁厚度均大于LC组;主动中转组手术时间、术中出血量、输血例数、术后引流量、排气时间、下床时间、术后住院时间均明显优于被动中转组。结论:上腹部手术史、急性胆囊炎发作、白细胞计数偏高及胆囊壁厚度增加均是中转开腹的危险因素,根据术中探查情况选择合适的中转开腹时机具有积极的临床意义。

Objective：To study the reason for conversion to open surgery and the opportunity selection of laparoscopic cholecystectomy（LC）.Methods：The patients who underwent LC successfully for cholecystolithiasis and cholecystitis were distributed into the LC group,and the open cholecystectomy（OC） group was divided into intended conversion group and forced conversion group according to the opportunity of conversion,then the risk factors of conversion、intraoperative and postoperative relative index were observed and recorded.Results：Compared withthe LC group,the OC group contained more cases who had underwent epigastrium operation ever before or been suffering of acute cholecystitis,had higher WBC count and thicker gall bladder wall.The intended conversion group was superior to the forced conversion group in operation duration,blood loss,transfusion rates,postoperative drainage,recovery of gastrointestinal function、offbed time as well hospital stay.Conclusions：History of epigastrium operation,attack of acute cholecystitis,higher WBC count and thicker gall bladder wall are major risk factors of conversion to open surgery.It is of important clinical value to select correct opportunity to conversion according to the intraoperative search.