腹腔镜胆囊切除术中转开腹手术105例临床分析

The Analysis of conversion to open cholecystectomy undergoing laparoscopic cholecystectomy

目的探讨腹腔镜胆囊切除术(LC)中转开腹的原因及防治措施。方法回顾性分析2003年1月至2012年12月我科收治3047例LC中105例中转开腹的临床资料,分析其中转开腹的原因并总结。结果本组患者的中转开腹率为3.45%,分析原因主要为胆囊三角严重粘连、解剖困难、胆囊管结石嵌顿、胆管损伤、大出血、意外胆囊癌等,105例患者经中转开腹后无严重并发症,均痊愈出院。结论准确严格把握LC手术适应证,术中规范、精细操作可有效降低中转开腹率,而当操作困难或对手术没把握时,应及时中转开腹以确保手术安全性。

objective To explore the reasons and the control measures of conversion to open cholecystectomy undergoing laparoscopic cholecystectomy. Methods The 105 clinic data out of 3047 cases, which were collected from January, 2003 to December, 2012, were retrospectively analysed to capture and summarize the reasons of conversion to open cholecystectomy. Results The rate of coversion to open choleeystectomy was 3.45% in this group, the main reasons were severe tissue adhesion in posterior callout＇ s triangle, anatomic difficulty, cholecystitis with gallstone incarcerated, bile duct injury, and massive haemorrhage no server complications were observed for the 105 cases of coversion to open cholecystectomy. Conclusion Maste the indication of laparoscopic cholecystectomy correctly, standard and careful operation can reduce the rate of conversion to open cholecystectomy, whereas, If the safe cannot be in sured, it should be conversion to open cholecystectomy in time.