腹腔镜胆囊切除术中转开腹35例原因及防治

目的探讨腹腔镜胆囊切除术(LC)中转开腹原因及降低中转开腹率的措施。方法对2005-12～2008-12收治的943例接受LC患者中中转开腹手术35例(3.71%)的临床资料、中转原因进行回顾性分析。结果胆管损伤2例,出血3例,腹腔胆囊周围粘连13例,胆囊三角解剖结构不清6例,胆囊十二指肠瘘1例,胆漏4例,Mirizzi综合征Ⅰ型和Ⅱ型6例。中转开腹手术35例均一次性完成胆囊切除,并对其并发症做了相应处理。结论重视术前对胆囊病变程度的判断以及术中采取预防措施可减少中转开腹。

The discussion on the causes and preventive measures in the laparoscopic cholecystectomy then converted to laparotomy

Objective To study the causes and prevention & treatment measures of that,i.e first undergone laparoscopic cholecystectomy(LC)and then converted to laparotomy.Method The study was based on 35 cases of conversions to laparotomy out of 943 cases of LC(3.71%)from December 2005 to December 2008 in authors' hospital retrospectively.Result The clinical data revealed a bile duct injury in 2 cases,bleeding in 3cases,severe adhesion in abdominal cavity or between the gallbladder and neighboring tissues in 13cases,disturbed anatomy and adhesion in Calot's triangle in 6 cases,cholecystoduodenal fistula in 1 case,bile leakage in 4 cases and Mirizzi syndrome(type I and type II)in 6 cases.The 35 cases converted to laparotomy were performed cholecystectomy primarily and successfully and subjected to treatment of complicatiaons.Conclusion Proper preoperative patient's selection and use of intraoperative preventive measures are helpful to minimize the possibility of conversion to open surgery.