腹腔镜胆囊切除术中转开腹的多因素分析  

Multivariate Analysis of Laparoscopic Cholecystectomy for Open Surgery

作　　者：沙广春[1] 王荣讯 张泉[1] 戴超 SHA Guangchun WANG Rongxun ZHANG Quan DAI Chao(Department of General Medicine, Pizhou Traditional Chinese Medicine Hospital Pizhou Jiangsu 221300, China)

机构地区：[1]江苏省邳州市中医院普外科,江苏邳州221300

出　　处：《中国继续医学教育》2017年第21期107-108,共2页China Continuing Medical Education

摘　　要：目的探究腹腔镜胆囊切除术中转开腹的因素原因与防治措施。方法选择2013年1月—2016年12月行腹腔镜胆囊切除术(LC)治疗的胆囊疾病患者190例作为研究对象。采用软件统计中转开腹出现的概率,并解析中转开腹原因。结果 190例胆囊疾病患者中,中转开腹6例(3.2%)。其中,术中出血难以控制2例(33.3%);胆囊三角区处理困难2例(33.3%);腹腔胆囊粘连严重1例(16.7%);胆总管损伤1例(16.7%),经中转开腹手术治疗以后,所有患者手术均成功,治愈后顺利出院。结论术者应该对胆道系统解剖结构有一定认识,熟练腹腔镜操作技术,并做好术前评估严格把握手术适应证,手术期间准确处理胆囊三角区内等重要组织,是降低腹腔镜胆囊切除术中转开腹出现率的有效办法。Objective To investigate the causes, prevention and treatment of laparoscopic cholecystectomy conversion to open surgery. Methods 190 patients with gallbladder diseases treated with laparoscopic cholecystectomy （LC） from January 2013 to December 2016 were selected as the study subjects. The probability of conversion to laparotomy was analyzed by software statistics, and the reasons for conversion to laparotomy were analyzed. Results Among 190 patients with gallbladder diseases, 6 cases were converted to laparotomy （3.2%）. Among them, intraoperative bleeding was difficult to control in 2 cases （33.3%）; The treatment of 2 cases （33.3%） was difficult in the gallbladder triangle area; Severe abdominal cavity and gallbladder adhesion occurred in 1 case （16.7%）; Common bile duct injuries occurred in 1 case （16.7%）, after conversion to open surgery, all patients were successfully operated and discharged successfully after treatment. Conclusion The patients of biliary anatomy shouldhave some knowledge, skilled laparoscopic operation technology, and make the assessment strictly grasp the surgical indications before operation, during the operation, accurate processing of important gallbladder triangle area, is an effective way to reduce the conversion rate of laparoscopic cholecystectomy.

关 键 词：胆囊切除术 腹腔镜 开腹手术 胆囊三角区 

分 类 号：R657[医药卫生—外科学]