肝外胆管结石腹腔镜胆总管探查术中转开腹原因分析

Analysis of the causes of conversion to laparotomy in laparoscopic common bile duct exploration for extrahepatic bile duct stones

目的分析肝外胆管结石腹腔镜胆总管探查术中转开腹原因。方法回顾性分析2014年1月-2018年12月医院开展的肝外胆管结石腹腔镜胆总管探查术患者416例的临床资料,其中腹腔镜下完成391例(腹腔镜组)、中转开腹25例(中转开腹组)。比较2组性别、年龄、体质指数(BMI)、既往腹部手术史、白细胞计数、结石大小、结石数目、有无胆总管管壁水肿及术中、术后情况。结果 2组性别、年龄、BMI指数、既往腹部手术史、白细胞计数比较差异无统计学意义(P>0.05)。中转开腹组结石最大径大于腹腔镜组,多发结石和胆总管管壁水肿发生率高于腹腔镜组,差异均有统计学意义(P<0.05)。中转开腹组手术时间和术后住院时间长于腹腔镜组,术中出血量多于腹腔镜组,差异均有统计学意义(P<0.01)。2组术后并发症发生率和围术期病死率比较差异均无统计学意义(P>0.05)。结论肝外胆管结石腹腔镜胆总管探查术中转开腹与结石较大、多发结石、胆总管管壁水肿有关,术前应加强影像学评估,重视合适病例的筛选。

Objective To analyze the causes of conversion to laparotomy in laparoscopic common bile duct exploration for extrahepatic bile duct stones.Methods The clinical data of 416 patients with extrahepatic bile duct stones undergoing laparoscopic common bile duct exploration in the hospital from January 2014 to December 2018 were retrospectively analyzed,among them,391 patients who underwent laparoscopic choledocholithiasis(laparoscopic group),and 25 patients who were converted to laparotomy(conversion group).The gender,age,body mass index(BMI),history of previous abdominal surgery,white blood cell count,stone size,number of stones,presence or absence of common bile duct wall edema,and intraoperative and postoperative conditions were compared.Results There were no significant differences in gender,age,BMI index,history of previous abdominal surgery,and white blood cell count between the two groups(P>0.05).The maximum diameter of stones in the conversion group was larger than that in the laparoscopic group,The incidence of edema in multiple stones and common bile duct wall was higher than that in the laparoscopic group,the differences were statistically significant(P<0.05).The operation time and postoperative hospital stay in the conversion group were longer than those in the laparoscopic group,the intraoperative blood loss was more than that in the laparoscopic group(P<0.01).There was no significant difference in the incidence of postoperative complications and perioperative mortality between the two groups(P>0.05).Conclusion The reasons for conversion to laparotomy in laparoscopic common bile duct exploration for extrahepatic bile duct stones are usually related to large stones,multiple stones and edema of common bile duct wall,the preoperative imaging evaluation should be strengthened,and the screening of suitable cases should be emphasized.