专题研究(Monographic Study)

腹腔镜胆囊切除术中转开腹的临床分析:附39例报告

Published at: 2017年第26卷第2期

罗东 1 , 刘国栋 1 , 唐能 1 , 纪连栋 1 , 李宜雄 1
1 中南大学湘雅医院 普通外科,湖南 长沙 410008
通讯作者 宜雄 李 Email: liyixiong2011@hotmail.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2017.02.005
基金:

摘要

目的:分析腹腔镜胆囊切除术(LC)中转开腹的原因及相关因素。方法:回顾性分析2010年1月—2015年12月3 849例行LC患者的临床资料。结果:3 849例患者中,中转开腹39例(1.01%),且中转开腹率在2010—2015年的各年度间差异无统计学意义(P=0.982)。中转开腹原因包括胆囊三角解剖结构不清16例,腹腔或胆囊周围粘连严重14例,Mirrizi综合征3例,胆囊动脉出血2例,胆汁漏、胆总管损伤、胆囊十二指肠瘘、胆囊癌各1例。早期中转开腹33例,中晚期中转开腹6例,后者中5例的中转开腹均因发生术中并发症而实施,包括2例胆囊动脉出血,1例因粘连紧密致胆囊破裂后胆囊三角结构不清,1例胆总管损伤,1例胆汁漏。性别、年龄、病程均为LC中转开腹的影响因素(均P<0.05)。高年资术者实施的LC中转开腹术后近期并发症发生率明显低于低年资术者(P=0.043)。结论:LC中有一定的中转率,胆囊三角处理困难,腹腔或胆囊周围粘连严重是中转开腹的主要原因,存在相关影响因素者应选择早期中转开腹以确保手术安全。


Clinical analysis of conversion from laparoscopic to open cholecystectomy: a report of 39 cases

Abstract

Objective: To analyze the reasons for conversion from laparoscopic cholecystectomy (LC) to open surgery and the related factors. Methods: The clinical data of 3 849 patients undergoing LC from January 2010 to December 2015 were retrospectively analyzed. Results: Among the 3 849 patients, 39 cases (1.01%) were converted to open surgery, and there was no significant difference in conversion rates among years during 2010 to 2015 (P=0.982). The reasons for open conversion included unclear anatomy of Calot’s triangle in 16 cases, severe abdominal or pericholecystic adhesions in 14 cases, Mirrizi syndrome in 3 cases, cystic artery bleeding in 2 cases, and bile leakage, common bile duct injury, cholecystoduodenal fistula and gallbladder cancer in 1 case each. Thirty-three patients underwent early open conversion, and 6 patients underwent intermediate or late conversion, and the open conversions in 5 cases in the latter were performed due to intraoperative complications that included cystic artery bleeding in 2 cases, obscure Calot’s triangle after gallbladder rupture and resultant dense adhesions in 1 case, common bile duct injury in 1 case and bile leakage in 1 case. Gender, age and course of disease were influential factors for conversion of LC (all P<0.05). The incidence of short-term postoperative complications of conversion of LC by senior surgeons was significantly lower than that by junior surgeons (P=0.043). Conclusion: There is a certain conversion rate during LC, difficulties in dissection of Calot’s triangle and severe abdominal or pericholecystic adhesions are main reasons for open conversion, and early open conversion is recommended in those with relevant influential factors to ensure surgical safety.


comments powered by Disqus

全文

引用

引用本文: 东 罗, 国栋 刘, 能 唐, 连栋 纪, 宜雄 李. 腹腔镜胆囊切除术中转开腹的临床分析:附39例报告 [J]. 中国普通外科杂志, 2017, 26(2): 157-165.
Cite this article as: LUO Dong, LIU Guodong, TANG Neng, JI Liandong, LI Yixiong . Clinical analysis of conversion from laparoscopic to open cholecystectomy: a report of 39 cases[J]. Chin J Gen Surg, 2017, 26(2): 157-165.