腹腔镜胆囊切除术中转开腹的临床分析

The clinical analysis of conversion from laparoscopic cholecystectomy to laparotomy

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中转开腹的原因,提高手术安全性。方法:回顾分析3 600例LC术中106例中转开腹的临床资料,并结合文献进行总结。结果:88例主动中转开腹,10例被迫中转开腹,8例术后延期开腹。被迫开腹及术后开腹的原因为出血、胆漏、腹膜炎、医源性损伤;主动开腹的原因为胆囊三角解剖困难,全组3例转上级医院,无死亡病例。结论:中转开腹手术并不意味着手术失败,也不是手术并发症,是明智之举。中转开腹受多种因素影响,术者职业素质及操作技术是手术成功的决定性因素,患者本身疾病状况是手术安全的主要因素,中转开腹本身并无绝对的手术指征,需强调术前风险评估。

Objective ： To discuss the reason of conversion of laparoscopic cholecystectomy （LC） to open operation,in order to enhance the security of the surgery. Methods：The clinical data of 106 conversion to open surgery in 3 600 LC were retrospectively ana- lyzed and summarized according to the literature. Results ：The initiative conversion to laparotomy occurred in 88 cases,passive conver- sion occurred in l0 cases,and delayed laparotomy in 8 patients. The reasons of passive and postoperative laparotomy included hemor- rhage, bile leakage, peritonitis and iatrogenic injury. The cause of initiative laparotomy was difficult anatomy in gallbladder triangle. 3 patients were transferred to the higher authority hospital, no death occurred. Conclusions：Conversion to opMa surgery is wise,it does not to mean the failure of surgery, and is not the surgery complication. Conversion to laparotomy is affected by many factors. The determining factors of operative success include professional quality and the operation technology of the surgeons. The primary factor of surgery secu- rity is disease status of patients. The indication of conversion to open surgery is not absolute, assessment of preoperative risk should be emnhasized.