单中心23年胆道外科腹腔镜手术中转开腹的原因分析

目的分析解放军总医院23年间胆道外科行腹腔镜手术中转开腹的情况,分析其中转开腹的常见疾病和原因。 方法根据相关纳入标准回顾性分析解放军总医院胆道外科1992年4月至2014年12月期间收治的连续348例腹腔镜手术中转开腹患者的临床资料,描述胆道外科腹腔镜手术的整体中转开腹情况,进而分析其中转开腹的常见病因及原因。 结果(1)解放军总医院胆道外科1992年4月起至2014年12月止23年间收治腹腔镜手术中转开腹患者共348例,总体中转开腹率为2.96%(348/11 767);其中11例患者有上腹手术史,其中转开腹率为25.58%(11/43)。(2)在所有患者中,最常见的中转开腹疾病是胆囊良性疾病和肝外胆管结石,分别占77.30%和16.67%。胆囊良性疾病的中转开腹率为2.41%,肝外胆管结石的中转开腹率为14.61%。(3)胆道外科腹腔镜手术常见中转开腹原因是粘连,占93.97%;其次是出血和癌变,分别占2.59%和2.30%,因损伤所致的中转开腹仅占1.15%。(4)对于胆囊良性疾病和肝外胆管结石患者而言,粘连是其最常见的中转开腹原因,分别占97.40%和98.28%。 结论胆道外科腹腔镜手术应严格掌握适应证,尤其是既往有上腹手术史的患者;如遇到无法控制的出血和损伤情况应及时中转开腹,以保证手术的安全。

Analysis of causes of laparoscopic surgery conversion to open surgery for biliary surgery among 23 years in a single center

ObjectiveTo analyze the common diseases and reasons of laparoscopic surgery conversion to open surgery in PLA General Hospital among 23 years. MethodsWe retrospectively analyzed the clinical data of 348 consecutive patients underwent with laparoscopic surgeryconversion to open surgery with biliary surgerydisease in Department of Hepatobiliary Surgery PLA General Hospital between Apr. 1992 and Dec. 2014 according to the inclusioncriteria. And then the common diseases and reasons were described. Results(1)From Apr. 1992 to Dec. 2014, the PLA General Hospital performed 348 cases of patients underwent with laparoscopic surgeryconversion to open surgery, the overall conversion rate was 2.96%(348/11 767). And 11 patients have history of abdominal surgery, the conversion rate was 25.58% (11/43). (2) In all patients, the most common disesases of conversion to open surgery were gallbladder benign disease and extrahepatic bile duct stone, which accounted for 77.30% and 16.67%. The rate of conversion to open surgery of gallbladder benign disease was 2.41%, and it was 14.61% in the extrahepatic bile duct stone patients. (3)The most common reason of conversion to open surgery in the laparoscopic surgery was adhesion, accounted for 93.97%. And then were hemorrhage and canceration, accounted for 2.59% and 2.30%. The injury reason of conversion to open surgery was only 1.15%. (4)For gallbladder benign diseases and extrahepatic bile duct stone patients, adhesion was the most common reason of conversion to opern surgery, accounted for 97.40% and 98.28%. ConclusionsLaparoscopic surgery should be strictly with the indications, in particular the history of upper abdominal surgery patients. We should timely conversion to opern surgery to ensure the operation safety when we encountered in uncontrollable hemorrhage or injury during the laparoscopic surgery.