腹腔镜胆囊切除术中转开腹的原因分析

目的：探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）中转开腹的原因与预防.方法：回顾分析苏州大学附属常熟市第一人民医院2005年1月 2011年12月行LC中转开腹患者的临床资料,对影响LC的因素进行统计学分析.结果：共有39例患者纳入本研究,其中男性22例,女性17例;年龄23～79岁,中位年龄54.9岁.其中主动中转开腹手术25例（64.1％）,原因包括胆囊与周围组织严重粘连、胆囊萎缩、胆囊壁增厚,这些因素导致胆囊三角区解剖结构不清甚至瘢痕化;被迫中转开腹手术14例（35.9％）,原因包括术中大出血、胆囊管或肝胆管解剖变异、气腹构建失败.结论：LC中转开腹的主要原因是胆囊三角区解剖变异,术前进行风险评估和严格掌握手术适应证有助于降低并发症的发生率.

Causes of the Conversion to Laparotomy in Laparoscopic Cholecystectomy

Objective：To study the causes and prevention of the conversion to laparotomy in laparoscopic cholecystectomy （LC）.Methods：The clinical datum of patients who underwent LC but converted to laparotomy from Jan 2005 to Dec 2011 were analyzed retrospectively in the First People＇s Hospital in Changsu,Suzhou University.Results：A total of 39 patients（22 males and 17 females; median age,54.9 years,ranged from 23 to 79 years）were included.Timely conversion to laparotomy was needed in 25 cases（64.1 ％） because of unclear anatomic structure in gallbladder triangle atrophy or thickening of gallbladder wall and even scaring response caused by severe adhesion of gallbladder with the surrounding tissues.Conversion to laparotomy was forced in 14 cases（35.9 ％） because of massive hemorrhage during surgery,anatomic variation of cystic duct or hepatic duct,or failure in construction of pneumoperitonieum.Conclusions：The main cause of the conversion to laparotomy in LC is unclear anatomic structure in gallbladder triangle.Preoperative risk assessment and strict control of the operation indications are helpful to reduce the rate of complications.