腹腔镜胆囊切除术中转开腹原因分析

Analysis of the causes leading to the conversion of laparoscopic cholecystectomy into open surgury

目的 总结腹腔镜胆囊切除术 (LC)中转开腹 (OC)原因。方法 回顾分析瑞金医院外科 2 0 0 0年 1月至 2 0 0 0年 1 2月施行的 1 4 2 3例LC中OC 40例的临床资料。结果 OC 40例 ,其中胆囊急性化脓性炎症、胆囊萎缩及胆道变异致Calot三角解剖结构关系不清 2 7例 ,胆管壁损伤 3例 ,出血 4例 ,腹腔广泛粘连3例 ,胆囊肠瘘 1例 ,胆囊癌 1例 ,结石性胆囊炎合并肝癌 1例。LC成功率 97 2 % ,OC率 2 8%。结论 LC术中中转OC不应视为失败 ,而是为了更好的降低并发症的发生率 ;腹腔镜术者的系统严格培训 ,对中转OC率尤为重要。

Objective To analyze the causes leading to the conversion of laparoscopic cholecystectomy(LC) into open surgery or open cholecystectomy(OC).Methods Data of 1423 cases of LC including 40 cases converting into OC,perfomed between Jan. 2000 and Dec. 2000 in the department of surgery,Rujin Hospital were reviewed retrospectively.Results There were 40 cases of conversion of LC into OC during operation,including 27 cases of disclearance of anatomic structure of Calot trianglanity resulting from acute supparative cholecystitis,atrophical gall bladder and disform of bile duct,3 cases of injury of bile duct wall,4 cases of bleeding,3 cases of difuse abdominal adhesion,1 case of intesrinal bladder fistula,1 case of gall bladder carcinoma,1 case of calculus cholecystitis combined with liver cancer.The success rate of LC was 97.2% and the rate of OC was 2.8%.Conclusion The endoscopic surgeon should take strict training.The conversion of LC into OC should not be considered as a kind of failure,but a useful way to reduce the complication rate.