腹腔镜胆囊切除术中转开腹的原因分析

目的:分析腹腔镜胆囊切除术(LC)中转开腹的原因及预防措施。方法:对14例LC中转开腹的临床资料进行回顾分析。结果:534例LC中,腹腔镜胆囊切除术成功率97.4%,中转开腹14例,占2.6%。其中被迫性中转开腹9例,占1.7%(胆囊局部粘连严重)。强迫性中转开腹5例,占0.9%(出血1例,胆瘘1例,施夹器故障1例,十二指肠损伤1例,结肠损伤1例)。结论:强调重视胆管和胆囊血管畸形,对胆囊急性炎症水肿或重度萎缩致Calot三角区三管结构关系不清的病例,果断AICL处理是LC避免损伤胆管、血管并发症的有效措施之一。严格手术程序可降低严重并发症发生率。

The Causes Resulting in Conversion to Laparotomy from Laparoscopic Cholecystectomy

Objctive:To investigate the causes resulting in conversion to laparotomy in laparoscopic cholecystectomy and their prevention.Methods:Fourteen laparotomy in laparoscopic cholecystectomy cases were reviewed retrospectively.Results:In 534 cases of laparoscopic cholecystectomy,14(2.6%) were converted to laparotomy.The success rate was 97.4%.The materials reveal severe adhesion in 9 cases(1.7%),bleeding in 1 case,biliary fistula in 1 case,clip appliers defect in 1 case,duodenum injure in 1 case,and colon injure in 1 case.Conclusion:Bile duct and cholecyst vasculae malformation should be emphasized.AICL is a good measure to avoid injure of bile duct when cholecyst adhesion.the major complication can be reduced by strict procedures of lapamscopic cholecystectomy.