普外科腹腔镜手术中转开腹原因的探讨

目的探讨普外科腹腔镜手术中转开腹的原因及其防治.方法回顾分析1999年6月-2005年12月间7574例接受普外科腹腔镜手术病例中83例中转开腹的原因.结果本组中转开腹率为1.10%(83/7574),主要原因为严重的腹腔粘连和大出血,分别为55.4%(46/83)和26.5%(22/83).另有恶性病变,病灶体积过大,器官损伤及暴露困难等.中转开腹率,有腹部手术史者20%(21/105),明显高于无腹部手术史者0.83%(62/7469),差异显著(P＜0.05).结论腹腔镜胰腺、肝、脾手术、有腹部手术史、严重出血和是腹腔粘连是中转开腹重要原因,术前应严格掌握腹腔镜手术指征,腹腔镜手术困难有可能导致严重并发症时应果断中转开腹手术.

Discussion about causes of laparoscopic operation of general surgery changing to open abdominal operation

Objective To study the causes changed from laparoscopic operation of general surgery to open surgery and their prophylaxis and treatments.Methods From June 1999 to Decenber 2005,the 83 of 7574 cases being transferred to open surgery were analyzed retrospectively.Results The rate of laparoscopic operation of general surgery changing to open surgery was 1.10%.Main causes converted to open surgery were severe adhesion(55.4%),severe bleeding(26.5%),a poor exposure of operative field,malignant lesions and organ injuries etc.The rate converted to open surgery in patients with a history of abdominal surgery(20.0%,21/105)was significantly higher than that in those without a history of abdominal surgery(0.83%,62/7469),P<0.05.Conclusions Laparoscopic operation on the pancreas,liver,spleen and a history of laparotomy,severe abdominal adhesions and massive bleeding are important reasons to change open surgery. If laparoscopic operation is very difficult and may be result in severe complications,the open abdominal operation should be converted in time.