腹腔镜胆囊切除术中转开腹93例临床分析

Analysis of the conversion to open surgery during laparoscopic cholecystectomy

目的探讨腹腔镜胆囊切除术(Laparoscopic Cholecystectomy;LC)中转开腹原因及降低中转开腹率的措施。方法对2006年10月～2011年9月收治的2376例接受LC治疗患者中,中转开腹手术93例的临床资料、中转原因进行回顾性分析。结果 LC中转开腹率3.91%,其中因腹腔、胆囊周围及胆囊三角区严重粘连、急性炎症术野渗血致解剖不清主动中转68例,占73.1%。术后没有严重并发症发生,术后平均住院日为11.5d;被动中转开腹(发生大出血、胆道损伤等并发症后中转开腹)病例25例,术后出现严重并发症,术后平均住院日为24.6d。结论当LC术中遇到Calot三角严重粘连、胆囊管结石嵌顿、胆囊萎缩及解剖变异等手术难度超出术者处理能力时应适时主动中转开腹以避免或减少并发症的发生。

Objective To study the causes of laparoscopic cholecystectomy（LC） convertion to laparotomy,how to seize the opportunity to laparotomy and seek the measures to decrease the percentage.Methods The study was based on 93 cases of conversions to laparotomy out of 2376 cases of LC（3.91%）.Results The conversion rate of LC was 3.91%.68 cases（73.1%） positively converted because of severe adhesion of abdominal cavity.The main causes were common bile duct injury and rapid hemorrhage in 25 cases receiving LC of passive conversion into surgery.The average postoperative stay for the active conversion into surgery was 11.5 days and 24.6 days for the passive conversion.conversion.In addition,there was no complication in active conversion into surgery versus complications in passive conversion into surgery.Conclusion The active conversion into surgery should be considered at the right moment for preventing or decreasing complications of LC once intensive dense adhesion of Calot＇S triangle,stone incarceration on the neck of the gallbladder,shrunken gallbladder and abnormal anatomy occurred during laparoscopic cholecystectomy.