急性坏疽性胆囊炎69例的腹腔镜治疗

目的 探讨腹腔镜治疗急性坏疽性胆囊炎中转开腹的危险因素及影响预后的指标。方法 总结69例急性坏疽性胆囊炎腹腔镜手术的临床资料，包含术前临床指标和预后相关因素。计量资料采用x^-±s表示，行t检验；计数资料行χ^2检验。结果 腹腔镜手术成功完成45例，中转开腹24例；中转开腹的危险因素为年龄（χ^2=2．234，P=0．034）和合并心血管疾病（χ^2=4．983，P=0．027）；早期行腹腔镜手术和术中及时中转开腹的病例预后较好。结论 急性坏疽性胆囊炎应早行腹腔镜探查，若操作困难，应早期及时中转开腹手术；对于高龄和合并有心血管疾病的患者，应行开腹胆囊切除术。

Laparoscopic cholecystectomy for the treatment of acute gangrenous cholecystitis: an analysis on 69 cases

Objective To evaluate the risk factors predicting a conversion of laparoscopic to open cholecystectomy and postoperative recovery of patients with acute gangrenous cholecystitis undergoing cholecystectomy. Methods Laparoscopic cholecystectomy was attempted in 69 patients with acute gangrenous cholecystitis. Preoperative clinical parameters as in the relation to the prognosis were evaluated. Results Laparoscopic cholecystectomy was successful in 45 patients, 24 patients were converted to open cholecystectomy. Advanced age along with coexistent cardiovascular disease were the risk factors for conversion of laparoscopic to open cholecystectomy. Results were satisfactory in patients when a laparoscopic cholecystectomy is performed at early stage and timely conversion of laparoscopic to open cholecystectomy in those with poor risks. Conclusions Laparoscopic cholecystectomy for acute gangrenous cholecystitis should be performed early. There are considerable high rates of intraoperative conversion of laparoscopic to open cholecystectomy in cases of acute gangrenous cholecystitis.