腹腔镜胆囊切除术中转开腹的原因分析(附5260例报告)

THE ANALYSIS OF THE CAUSE OF THE CONVERSION TO LAPAROTOMY IN LAPAROSCOPIC CHOLECYSTECTOMY(WITH A REVIEW OF 5 260 CASES OF LAPAROSCOPIC CHOLECYSTECTOMY).

目的 了解我国目前腹腔镜胆囊切除术中转开腹的原因。方法 对 1994-1999年期间有关文献及本院腹腔镜胆囊切除术和中转开腹的病例数及原因进行统计和分析。结果 5 2 60例腹腔镜胆囊切除术中 ,中转开腹 169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 (0 .42 % ) ,出血 2 5例 (0 .48% ) ,腹腔内粘连 81例 (1.5 4% ) ,急性胆囊炎 16例 (0 .3 % ) ,胆漏 3例 (0 .0 6% ) ,术中发现胃癌 1例 (0 .0 2 % ) ,胆囊癌及“瓷”胆囊 10例 (0 .2 % ) ,胆总管增宽及结石 4例 (0 .8% ) ,胆囊内瘘 2例 (0 .0 4% ) ,胃及肠管损伤 4例 (0 .0 8% ) ,因气腹不满意无法完成手术 1例 (0 .0 2 % )。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 in laparoscopic cholecystectomy,and weigh up its clinical implications.Methods correlative literatures were retrieved from 1994 to 1999,and were tabulated and critically appraised in terms of sample size,outcomes,and the cause of the conversion to laparotomy.Results In the 5 260 cases of LCs,169(3.21%) convert to laparotomy.The materials examination reveal a bile duct injury in 22 cases(0.42%),bleeding in 25(0.48%),severe adhesion in 81(1.54%),acute cholecystitis in 16(.3%),leakage of bile in 3 (0.06%),gastric cancer in 1(0.02%),carcinoma of gallbladder in 10(0.2%),distension of common bile duct and choledocholith in 4 (0.08%),fistula of gallbladder in 2(0.04%),injury of stomach or bowel in 4(0.08%),unsatisfactory pneumoperitoneum in 1(0.02%).Conclusion The major causes of the conversion to laparotomy in laparoscopic cholecystectomy are severe adhesion,injury of bile duct and bleeding.