腹腔镜肝切除术治疗肝内胆管结石中转开腹的原因分析及预防

目的 探讨腹腔镜肝切除术治疗肝内胆管结石中转开腹的原因以及预防措施.方法 回顾性分析2015年1月至2020年8月浙江省人民医院收治的165例因肝内胆管结石行腹腔镜肝切除术,其中15例中转开腹患者的临床资料.结果 本组资料中转开腹率为9.1％(15/165),其中男6例,女9例,年龄34～75岁,中位年龄57岁;肝功能...

Causes and prevention of conversion to laparotomy in treatment of intrahepatic bile duct stones by laparoscopic hepatectomy

Objective To investigate the causes and prevention of conversion to laparotomy in treatment of intrahepatic bile duct stones by laparoscopic hepatectomy.Methods Retrospective analysis was performed on clinical data of patients underwent laparoscopic hepatectomy for intrahepatic bile duct stones in Zhejiang Provincial People’s Hospital from Jan.2015 to Aug.2020 and.Results Among 165 patients,15 were transferred to laparotomy,the conversion rate was 9.1%;which including 6 males and 9 females,aged 34 to75 years,with a median age of 57 years;the Child-Pugh grades of liver function were all A/B.One patient was complicated with hypertension,and 1 patient was complicated with diabetes mellitus.Nine patients had abdominal surgery history.The average operation time was(245.7±55.3)min,and the average intraoperative blood loss was(383.3±321.5)mL.The causes for conversion to laparotomy:9 cases with severe intraperitoneal adhesions,2 cases with obvious hepatic translocation,2 cases with difficulty in hemostasis during operation,and 2 cases with right hepatic duct stenosis.Postoperative complications:celiac infection in 2 cases,pleural effusion in 4 cases,celiac infection with biliary tract infection in 1 case,and pleural effusion with biliary tract infection in 1 case.All patients were cured by conservative treatment.The average postoperative feeding time was(2.5±2.1)d,the average postoperative extubation time was(8.5±2.5)d,and the average postoperative hospitalization time was(13.7±3.9)d.All 15 patients were discharged from hospital without perioperative death.Conclusion Severe intra-abdominal adhesions,significant liver translocation,intraoperative hemorrhage and hemostasis difficulty,and hepatic duct stricture where stones located are common causes for the conversion to laparotomy in treatment of intrahepatic bile duct stones by laparoscopic hepatectomy.Positive and reasonable methods should be adopted to avoid conversion to laparotomy,but timely conversion to laparotomy should also be adopted to ensure the safety of patients.