CAJ | 학술논문

目的探讨腹腔镜胆囊切除术中转开腹的原因及预防措施。方法回顾性分析2007年2月至2013年1月在广东省潮州市中心医院收治的770例行腹腔镜胆囊切除术中30例中转开腹患者临床资料。其中男13例，女17例；年龄25～81岁，中位年龄48岁。所有患者均签署知情同意书，符合医学伦理学规定。患者采用气管插管全身麻醉，常规“四孔”法行腹腔镜胆囊切除术。观察患者腹腔镜胆囊切除术中转开腹的原因及术后并发症发生情况。结果本组患者腹腔镜胆囊切除术中转开腹发生率为3.9%（30/770）。中转开腹原因为胆囊三角粘连12例，胆囊床出血6例，胆囊动脉出血4例，胆囊周围粘连致密分离困难4例，胆囊管残端处理不满意2例，肝面裂伤1例，胆囊癌1例。患者中转开腹后均一次性完成手术。患者术后均无发生并发症。结论腹腔镜胆囊切除术中转开腹的常见原因为胆囊三角及胆囊周围解剖不清楚、胆囊床或胆囊动脉出血、胆囊管残端处理不满意、肝面裂伤、胆囊癌等。完善术前评估、术中合理处理胆囊三角和胆囊床是预防腹腔镜胆囊切除术中转开腹的关键。
목적탐토복강경담낭절제술중전개복적원인급예방조시。방법회고성분석2007년2월지2013년1월재광동성조주시중심의원수치적770례행복강경담낭절제술중30례중전개복환자림상자료。기중남13례，녀17례；년령25～81세，중위년령48세。소유환자균첨서지정동의서，부합의학윤리학규정。환자채용기관삽관전신마취，상규“사공”법행복강경담낭절제술。관찰환자복강경담낭절제술중전개복적원인급술후병발증발생정황。결과본조환자복강경담낭절제술중전개복발생솔위3.9%（30/770）。중전개복원인위담낭삼각점련12례，담낭상출혈6례，담낭동맥출혈4례，담낭주위점련치밀분리곤난4례，담낭관잔단처리불만의2례，간면렬상1례，담낭암1례。환자중전개복후균일차성완성수술。환자술후균무발생병발증。결론복강경담낭절제술중전개복적상견원인위담낭삼각급담낭주위해부불청초、담낭상혹담낭동맥출혈、담낭관잔단처리불만의、간면렬상、담낭암등。완선술전평고、술중합리처리담낭삼각화담낭상시예방복강경담낭절제술중전개복적관건。
Objective To investigate the causes and prevention of conversion to laparotomy during laparoscopic cholecystectomy. Methods Clinical data of 30 out of 770 patients converting to laparotomy during laparoscopic cholecystectomy in Guangdong Chaozhou Central Hospital from February 2007 to January 2013 were analyzed retrospectively. There were 13 males and 17 females with age ranging from 25 to 81 years old and a median age of 48 years old. The informed consents of all patients were obtained and the ethical committee approval was received. Laparoscopic cholecystectomy was performed in the patients under endotracheal general anesthesia using the conventional 4-port approach. The causes of conversion to laparotomy during laparoscopic cholecystectomy and the incidence of postoperative complications of the patients were observed. Results The incidence of conversion to laparotomy during laparoscopic cholecystectomy was 3.9%(30/770). The causes of conversion to laparotomy were adhesion at Calot's triangle (n=12), gallbladder bed bleeding (n=6), gallbladder artery bleeding (n=4), dense adhesion around the gallbladder with difficult dissecting (n=4), dissatisfactory treatment of the gallbladder stump (n=1), liver surface laceration (n=1), gallbladder carcinoma (n=1). All the converted laparotomies were completed at one time. No complication was observed in all patients after operation. Conclusions The common causes for conversion to laparotomy during laparoscopic <br> cholecystectomy were unclear dissection at Calot's triangle and around the gallbladder, gallbladder bed or gallbladder artery bleeding, dissatisfactory treatment of gallbladder stump, liver surface laceration, gallbladder cancer, etc. Improving the preoperative evaluation, intraoperative appropriate treatment of the Calot's triangle and gallbladder bed are the keys to prevent conversion to laparotomy during laparoscopic cholecystectomy.