腹腔镜胆囊切除术中转开腹原因及意义探讨(附5260例报告)

A study on the cause of the conversion to laparotomy during laparoscopic cholecystectomy with a review of 5260 cases of laparoscopic cholecystectomy

目的 了解目前我国腹腔镜胆囊切除术中转开腹的原因。 方法 对 1994年～ 1999年期间有关文献报道腹腔镜胆囊切除术中转开腹的病例数及原因进行统计和分析。 结果 5 2 6 0例腹腔镜胆囊切除术中 ,中转开腹 16 9例 ,中转手术率为 3 2 1%。中转手术的主要原因为 :胆道损伤 2 2例 (13% ) ,出血 2 5例 (14 8% ) ,腹腔内粘连 81例 (48% ) ,急性胆囊炎 16例 (9 5 % ) ,胆漏 3例 (1 8% ) ,术中发现胃癌 1例 (0 .6 % ) ,胆囊癌及“瓷”胆囊 10例 (6 % ) ,胆总管增宽及结石 4例 (2 4 % ) ,胆囊内瘘 2例 (1 2 % ) ,胃及肠管损伤 4例 (2 4 % ) ,因气腹不满意无法完成手术 1例 (0 .6 % )。 结论 腹腔镜胆囊切除术中转开腹的主要原因依次为腹腔内严重粘连。

Objective To study the reasons of the conversion to laparotomy during laparoscopic cholecystectomy. Methods Correlative literatures were retrieved from 1994 to 1999, and were tabulated and critically appraised in terms of sample size, outcomes, and the causes of the conversion to laparotomy. Results In the 5260 cases of LCs, 169(3.21%) converted to laparotomy. The data examined revealed a bile duct injury in 22 cases (13%), bleeding in 25(14.8%), severe adhesion in 81(48%), acute choecystitis in 16(9.5%), bile leakage in 3 (1.8%), gastric cancer in 1(0.6%), carcinoma of gallbladder in 10(6%), distension of common bile duct and choledocholith in 4 (2.4%), fistula of gallbladder in 2 (1.2%), injury of stomach or bowel in 4(2.4%), unsatisfactory pneumoperitoneum in 1 (0.6%). Conclusions The major causes of the conversion to laparotomy during laparoscopic choecystectomy are severe adhesion, injury of bile duct and bleeding.