腹腔镜胆囊切除术即刻中转开腹原因分析

目的 :探讨腹腔镜胆囊切除术 (LC)中即刻中转开腹手术的原因 ,LC术前难易程度的判定及即刻中转开腹的指征。方法 :回顾分析我院 1991年 3月至 2 0 0 2年 7月 1185 6例LC即刻中转开腹的临床资料。结果 :LC即刻中转开腹手术发生率为 2 4 1% ,主要原因为以往有急性胆囊炎病史、近期有发作史 ,胆囊周围粘连、胆囊颈部结石嵌顿、Calot三角解剖不清、难以辨认胆囊管及胆总管是否有损伤。结论 :胆囊病变如有急性胆囊炎发作史 ,近期有急性发作史 ,应慎重选择LC ,并掌握好中转开腹的时机及开腹后处理方法 ,是降低LC手术并发症的有效措施

Analysis of cause of immediate laparotomy in laparoscopic cholecystectomy

Objective:To discuss the causes of transferring to open laparotomy when the laparoscopic cholecystectomy(LC) is being done, and to discuss the indication of immediate laparotomy and judge the degree of difficulty before LC. Methods:The clinical data of 11?856 cases of LC were retrospectively analyzed.Results:The occurrence rate of transferring was 2 41%. The main causes were the patient's history of acute cholecystitis and recent acute outbreak, adhesion around gallbladder, stone incaracration on the neck of gallbladder and unclear discrimination of Calot's triangle, and damage in choledochus. Conclusions:It must be careful to choose the indication of LC,if the patient has history of acute cholecystitis or recent acute outbreak. It's an important step that surgeon predominate correctly opportunity and operable way of immediate laparotomy so as to decrease complication of LC.