腹腔镜胆囊切除术中转开腹的临床分析

目的　探讨腹腔镜胆囊切除术 (LC)中主动中转开腹对减少并发症 ,提高手术质量的重要性。方法　对比分析我院 94例LC主动与被动中转开腹的原因及手术效果。结果　主动中转开腹 79例 ,主要原因为Calot三角严重粘连、胆囊管结石嵌顿、胆囊萎缩及解剖变异。平均手术时间为5 0min ,术后平均住院时间为 8.5d ,无并发症发生。被动中转开腹 1 5例 ,主要原因为术中胆管损伤、大出血及胃肠损伤。平均手术时间为 91min ,术后平均住院时间为 1 4 .4d ,有 6例并发症发生。两者之间有显著性差异 (P <0 .0 1 )。结论　当LC术中遇到Calot三角严重粘连、胆囊管结石嵌顿、胆囊萎缩及解剖变异等手术难度超出术者处理能力时应适时主动中转开腹以避免或减少并发症的发生。

Comparative study of active and passive conversion into open surgery during laparoscopic cholecystectomy

Objective To discuss the importance of active conversion into surgery for decreasing complications and achieving better operative results during laparoscopic cholecystectomy(LC).Methods The causes and operative results of active and passive conversion into surgery were comparatively reviewed in 94 patients undergoing LC.Results The main causes were intensive dense adhesion of Calot's triangle, stone incarceration on the neck of the gallbladder,shrunken gallbladder and abnormal anatomy in 79 cases undergoing LC of active conversion into surgery.The main causes were common bile duct injury,rapid hemorrhage and gastro intestinal injury in 15 cases receiving LC of passive conversion into surgery.The average operating time and postoperative stay for the active conversion into surgery were 50 min and 8.5 days versus 91 min and 14.4 days respectively for the passive conversion into surgery( P < 0.01 ).In addition,there was no complication in active conversion into surgery versus 6 complications in passive conversion into surgery( P < 0.01 ).Conclusion The active conversion into surgery should be considered at the right moment for preventing or decreasing complications of LC once intensive dense adhesion of Calot's triangle,stone incarceration on the neck of the gallbladder,shrunken gallbladder and abnormal anatomy occurred during laparoscopic cholecystectomy.