急性炎症期腹腔镜胆囊切除术中转开腹原因分析.docVIP

急性炎症期腹腔镜胆囊切除术中转开腹原因分析 　【摘要】 　　目的：探讨急性炎症期腹腔镜胆囊切除术中转开腹的原因与防治。方法：回顾分析651例急性炎症期胆囊炎患者行腹腔镜胆囊切除术的临床资料。结果：腹腔镜胆囊切除术成功９３５例（97.54%）,中转开腹16例（2.46%）。其中因胆囊三角解剖不清、胆囊与周围组织紧密粘连，主动中转开腹11例（1.69%），被动中转开腹的5例（0.77%）中胆管损伤2例，出血3例。结论：急性炎症期腹腔镜胆囊切除术是安全可行的，正确处理胆囊三角是降低LC并发症及中转开腹率的有效措施。 【关键词】 胆囊炎　急性　胆囊切除术　腹腔镜　中转开腹 　　The analysis of the conversion to laparotomy in laparoscopic cholecystectomy for acute cholecystitis 　　【Abstract】Ｏbjective:To explore the reasons and preventive approaches of the conversion to laparotomy in laparoscopic cholecystectomy(LC) on patients with acute cholecystitis.Methods:The data of 651 patients with acute cholecystitis undergoing LC were retrospectively analyzed.Results:In this group,the achievement rate of LC was 97.54%.16(2.46%)cases were converted to laparotomy.Among those conversions,11(1.69%)cases belonged to initiative conversions(difficult dissection of Calot’s triangle,and severe adhesions of gallbladder with surrounding tissues);5 cases(0.77%)belonged to obliged conversions(2 cases of injury of bile duct,and 3 cases of hemorrhage).Conclusions:LC in patients with acute cholecystitis is safe and feasible.It is effective to deal with Calot’s triangle correctly in reducing the rate of complications and conversion to laparotomy. 　　【Key words】 Cholecystitis,acute;Cholecystectomy,laparoscopic;Conversion to laparotomy 2002年1月至2006年6月我院共开展腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)1 182例,其中处于急性炎症期651例,中转开腹16例,现报道如下。 　　1 资料与方法 　　1.1 临床资料 　　本组中转开腹的16例中男6例,女10例,25～80岁,平均52.5岁。病程1个月至30年，均为急性炎症期胆囊炎。既往有腹部手术史2例,其中剖宫产、阑尾切除术各1例。伴有高血压心脏病史2例,糖尿病4例。 　　1.2 中转原因 　　主动中转开腹１１例，被动中转开腹５例。原因是术中出血3例(胆囊动脉、右肝动脉、胆囊床各出血1例),胆囊管结石嵌顿1例,胆总管结石2例，胆囊三角解剖不清5例,胆囊与周围组织紧密粘连3例,胆道损伤2例。 　　2 结 果 16病例中转开腹手术。(1)术中大出血,开腹行胆囊动脉结扎、右肝动脉修补、胆囊床缝合结扎并行胆囊切除术；(2)胆囊管嵌顿、胆总管结石、胆囊三角解剖不清、胆囊与周围组织紧密粘连,钛夹不能完全钳闭胆囊管者,开腹行胆囊切除术、胆总管切开取石；(3)术中胆道损伤者行胆总管端端吻合T管引流术,术后６月拔管。改变手术方式后本组病例均痊愈出院。 　　3 讨 论 急性胆囊炎Calot三角水肿，粘连增厚，解剖不清，增加了手术难度，部分病例需中转开腹或发生严重并发症。本研究主要探讨急性炎症期ＬＣ中转开腹的原因与防治。 　　3.1 术前评估与中转开腹 　　急性胆囊炎行ＬＣ ２０％～３０％的患者需中转开腹或发生严重的并发症［１］。因此,术前综