CAJ | 학술논문

目的：探讨腹腔镜胆囊切除术（ LC）中转开腹的原因、时机及并发症的防治。方法：回顾性分析我院2008年7月～2013年7月施行的1492例LC中37例中转开腹的临床资料。结果：LC中转开腹发生率为2．48％，其原因包括急性炎症期胆囊、胆囊萎缩、胆囊周围炎症粘连，胆囊三角解剖不清，不能处理胆囊颈部结石嵌顿，术中无法控制的出血，胆管损伤、胃肠道损伤，胆肠内瘘，Mirizzi 综合征，胆囊癌等。结论：正确掌握中转开腹的时机是降低LC手术并发症的关键。术前对LC难易程度的准确评估、适应症的严格把握和提高腹腔镜技术水平可降低LC中转开腹的发生率。
목적：탐토복강경담낭절제술（ LC）중전개복적원인、시궤급병발증적방치。방법：회고성분석아원2008년7월～2013년7월시행적1492례LC중37례중전개복적림상자료。결과：LC중전개복발생솔위2．48％，기원인포괄급성염증기담낭、담낭위축、담낭주위염증점련，담낭삼각해부불청，불능처리담낭경부결석감돈，술중무법공제적출혈，담관손상、위장도손상，담장내루，Mirizzi 종합정，담낭암등。결론：정학장악중전개복적시궤시강저LC수술병발증적관건。술전대LC난역정도적준학평고、괄응증적엄격파악화제고복강경기술수평가강저LC중전개복적발생솔。
Objective:To investigate the risk factors,timing of conversion to laparotomy and prevention of the complications during laparoscopic cholecys-tectomy(LC).Methods:The clinical data were reviewed in 37 of 1 492 cases undergone LC requried conversion to laparotomy in our hospital during July 2008 and July 2013.Results:2.48% of the LC required conversion to open surgery.The risk factors were associated with acute inflammation of the gall-bladder,atrophy of the gallbladder,adjacent adhesion caused by tissue inflammation,unclearly defined Calot′s triangle,failure removal of the stone(s) at the neck of the gallbladder due to incarceration,inability to control the intraoperative bleeding,damaged bile duct or gastrointestinal tract,biliary enteric fistula,Mirizzi syndrome,gallbladder carcinoma and the like.Conclusion:It is critical to reduce the complicaitons of LC by right timing of conversion to open surgery.Besides,careful preoperative evaluation on the degree of difficulty and surgical indications as well as skillful performance can reduce the inci-dence of LC to open surgery.