31例腹腔镜胆囊切除术中转开腹手术治疗体会

目的探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）中转开腹手术的经验。方法回顾性分析我院2006年1月至2008年12月1430例LC患者的临床资料中31例中转开腹者。结果31例中转开腹病例中，胆囊三角解剖不清20例，术中胆道损伤2例，术中腹腔内出血4例，术中发现可疑胆总管结石3例，胆囊癌1例，另有穿刺致小肠损伤1例，占同期全部LC手术病例2．17％。所有患者均随访，半年内无异常发现。结论熟悉Calot三角关系，适时中转开腹是LC的安全保障。

The clinical analysis of 31 cases of laparotomy seconalart to laparoscopic cholecystectomy

Aim To probe into laparoscopic cholecystectomy （LC） and transfer the experience of convert to open procedure. Methods Review and analyse that 31 cases and convert to open procedure among 1 430 LC patient＇s clinical materials from January of 2006 to December of 2008 of our academy. Results The overall conversion rate was 2.71% （ 31 patients）, The operative complications included abdominal cavity internal bleeding in 4 patients, bile duct injury in 2 cases, intestinal injury in 1 cases, disturbed anatomy and adhesion in the region of the Calots＇triangle in 20 cases,carcimoma of gallbladder of 1 cases ,suspect choledocholith in 12 cases. Without operation complication,31 follow up a case by regular visits to and has not unusually found in half a years. Conclusion The appropriate choice of operative indication, being familiar with the anatomic structure of Calot＇ s triangle and conversion to open surgery if necessary is the key of operative success.