腹腔镜胆囊切除术中转开腹原因分析

Analysis of conversions to open surgery during laparoscopic cholecystectomy

目的分析腹腔镜胆囊切除术中转开腹的原因。方法回顾性分析2003年1月～2012年5月我院腹腔镜胆囊切除术1320例,中转开腹原因进行统计和分析。结果 1320例胆囊切除术中转开腹49例,中转手术率3.71%。中转手术的主要原因为胆囊三角区粘连、解剖不清、难以分离26例(53.1%)、大网膜与肠道与腹壁粘连导致胆囊无法暴露2例(4.1%)、胆囊炎症严重,易碎或肿胀10例(20.4%)、胆囊明显增厚,怀疑胆囊癌1例(2%)。胆囊颈管结石嵌顿7例(14.3%)、术野出血1例(2%)、腹腔严重粘连,不能建立气腹1例(2%)、发现或怀疑有医源性胆管损伤1例(2%)。结论为降低中转开腹率,应严格掌握腹腔镜手术的指征,着重处理好胆囊三角,确有困难应及时开腹手术。

Objective Analysis of the conversion to open surgery during laparoscopic cholecystectomy causes.MethodsA retrospective analysis of 1320 cases of laparoscopic cholecystectomy during January 2003-May 2012 in our hospital,statistics and analysis of conversion to open laparotomy.Results 49 cases of conversions to open surgery in 1320 cases of laparoscopic cholecystectomy,transit operation rate of 3.71%.Main cause of transit operation include： 26 cases of gallbladder triangle adhesion,anatomy not clear and difficulty to separate（53.1%）,2 cases of omentum and abdominal wall adhesions resulting in gallbladder cannot be exposed（4.1%）,10 cases of severe inflammation of the gallbladder,fragile or swelling（20.4%）,1 case of gallbladder significantly thickened,suspicion of gallbladder carcinoma（2%）,7 cases of neck of gallbladder calculus incarceration（14.3%）,1 case of hemorrhage of surgery area,1 case of severe abdominal cavity adhesion,cannot establish pneumoperitoneum（2%）,1 case of detected or suspected iatrogenic biliary passage injury（2%）.Conclusion In order to reduce the rate of conversion to open surgery in laparoscopic operation,we should strictly control the indications,handle Calot′s triangle,if case of difficulties should conduct timely open operation.