腹腔镜胆囊切除术中转开腹的原因分析及对策

目的讨论腹腔镜胆囊切除术(LC)中转开腹的原因并提出减少中转开腹率的对策。方法对2001年12月至2008年12月7年间收治的31例行LC术中中转开腹的患者的临床资料进行回顾性分析。结果造成LC中转开腹的原因有9种:①术中出血;②胆囊管部结石嵌顿;③胆囊三角解剖不清;④胆囊管增粗;⑤萎缩性胆囊炎;⑥腹腔内粘连;⑦术中发现胆总管结石;⑧术中损伤十二指肠;⑨急性胆囊炎并胆囊壁坏死。结论对以上9种原因提出了预防及LC术中即刻处理措施以期降低LC术中中转开腹的手术率。

The Analysis and Countermeasures about Laparoscopic Conversion of Laparoscopic Cholecystectomy

Objective To explore the risk factors for conversion of laparoscopic cholecystectomy（LC）to open cholecystectomy（OC）,and propose counter-measures to reduce the rate of conversion.Methods In the past 7 years from 12,2001 to 12,2008,a total of 31 cases underwent routine LC covered to OC were reviewed retrospectively.Results There are 9 kinds of reasons resulted in LC converted to OC.①Bleeding in operation.②Incarcerated by cystic duct stones.③Unclear of the Calot＇s Triangle.④ Cystic duct thickening.⑤Atrophic cholecystitis.⑥Intraperritoneal adhension.⑦Common bile duct stones in operation.⑧Duodenal injury in operation.⑨Acute cholecystitis and gallbladder wall necrosis.Conclusions By the above 9 kinds of reasons,propose the immediate prevention and treatment measures and put forward to reduce the rate of LC to OC.