急性胆囊炎LC中转开腹的危险因素

目的探讨腹腔镜胆囊切除术(LC)中导致中转开腹的危险因素。方法将122例患者分为LC成功组115例和中转开腹组7例，分析其年龄、最高体温、既往发作史、发作至手术时间、白细胞计数、血清总胆红素、碱性磷酸酶、胆囊肿大、胆囊坏疽、胆结石大小、胆囊颈结石嵌顿对中转开腹的影响。结果中转组7人均为胆囊炎发作72h之后手术，与成功组的23／115(20％)相比，有极显著性差异(P<0．01)。中转组既往发作均超过10次，而成功组中仅有27人(23％)发作超过10次，两组之间有极显著性差异(P＜0．01)。术前最高体温、白细胞计数、血清总胆红素、碱性磷酸酶、胆囊积脓以及胆囊结石大小在两组间均无显著性差异(P>0．05)。胆囊肿大超过10cm、胆囊颈结石嵌顿使中转开腹率大大提高，两组间有显著性差异(P<0．05，P<0．01)。结论年龄大于65岁的急性胆囊炎患者，既往发作超过10次，本次发作超过72h，术前B超示胆囊肿大超过10cm，胆囊颈结石嵌顿时，应直接选择开腹胆囊切除术。

The risk factors of conversion of laparoscopic cholecystectomy in treatment of acute cholecystitis

Objective To analyze the risk factors of conversion of laparoscopic cholecystectomy (LC) in treatment of acute cholecystitis.Methods 122 patient with acute cholecystitis underwent LC in which 7 needed conversion to open cholecystectomy.Possible risk factors for conversion have been analyzed such as age,maximum body temperature, previous biliary symptoms, duration of acute symptoms, white blood cell count,total bilirubin,alkaline phosphatase,gallbladder diameter,gangrenous gallbladder,maximum gallstone size,impacted stone at the cystic duct.Results The seven patients in conversion group were operated after the acute symptoms had lasted for more than 72 hours,yet only 23 of 115 patients in success group were operated after that time ( P <0.05).7 of 7 (100%) and 27 of 115(23%) patients in two groups had previous biliary symptoms for more than 10 times.Patients with distended gallbladders and impacted stone at the cystic duct had a higher conversion rate.Maximum body temperature, white blood cell count,total bilirubin,alkaline phosphatase,gangrenous gallbladder,maximum gallstone size between two groups showed no statistical significance.Conclusions Elderly patients over 65,with previous biliary symptoms for more than ten times,duration of acute symptoms for more than 72 hours this time,and a distended gallbladders over 10*!cm,open cholecystectomy should be directly selected.