腹腔镜胆囊切除术中转开腹及近期再次手术原因分析和中转开腹时机探索

目的分析腹腔镜胆囊切除术（LC） 中转开腹及近期再手术原因并探讨中转开腹时机。方法回顾性分析我院850例LC中49例中转开腹及10例术后近期再手术临床资料。结果 LC 中转开腹手术原因： 胆囊三角解剖欠清、胆囊粘连32例,腹腔内出血6例,胆管损伤4例,发现胃癌1例,意外胆囊癌2例,胆总管结石3例,腹腔镜器械原因1例。近期再次手术原因： 肝总管横断损伤及胆囊管根部损伤各1例,迷走胆管漏2例,胆总管结石残留 3 例,腹腔出血 3例。结论选择合适病例,严格掌握中转开腹时机,就可以减少LC并发症的发生。

The analysis and exploration of the opportunity on conversion to laparatomy in laparscopic cholecystec- tomy and its recent reoperation

Objective To study the reasons of the conversion to laparotomy in Laparoscopic cholecys- tectomy （LC） and its rencent reoperation, and to explorate the opportunity selection of conversion to Laparato- my. Methods Retrospective rewiew of 49 cases of coversion to Laparatomy and 10 cases of recent reoperation which were out of 850 cases of LC from Janunary 2002 to Janunary 2011 in this hospital. Results 49 cases conversion to Laparatomy, 32 cases of them were due to the blurred dissection on calofs triangle under LC and adhesions to gaUblander, 6 cases of them were due to intra-abdominal hemorrhage, 4 cases of them were due to bile duct injury, 1 case of them was due to gastric cancer, 2 cases of them were due to gallbladder cancinoma, 3 cases of them were due to commom bile duct stone, 1 case of them was due to the failure of the Laparoscopic device. In addition, 10 cases underwent recent reoperation, 1 case of them was due to transecting injury of the commom bile duct, 1 case of them was due to the fundus of gallbader injury, 2 cases of them were due to lusch- ka duct leakage, 3 cases of them were due to commom bile duct stone remained ,3 cases of them were due to in- tra-abdominal hemorrhage. Conclusion Choosing the suitable cases, and grasping the opportunity on conver- sion to Laparotomy strictly, it can reduce the complication of LC.