Koreshkin I A, Panshin A A, Loĭt A A, Lebedev A K
Vestn Khir Im I I Grek. 2000;159(1):50-4.
Based on an analysis of personal observations and literature data the authors made an analysis of the frequency and causes of unsuccessful laparoscopic cholecystectomy (LChE) resulting in laparotomy (conversion). LChE was successful in 217 of 233 operations. In 16 patients (6.9%) conversion was performed. According to the summary data of the literature on 150,000 cases of LChE the frequency of conversion was from 0.9 to 18%. The frequency of conversions was found to depend on the strategy of determining the indications for LChE and on the level of technological maintenance of operations. Three groups of the causes of conversion were set up on the basis of an analysis of publications about 498 cases of unsuccessful attempts of LChE and 16 personal observations: pathomorphological (393--78.9%; 7--43.8%); iatrogenic (99--19.9%; 7--43.8%) and technico-instrumental (6--1.2%; 2--12.4%). The pathomorphological causes lead to noncomplicated conversion and indicate to the limited use of LChE for the concrete patients. The iatrogenic and technico-instrumental causes appear all of a sudden and require emergent laparotomy. So the total frequency of conversion can not be a criterion for the assessment of complications after LChE. It is expedient to make a special analysis of the causes of transition to laparotomy and to distinguish the complicated and not complicated conversion.
基于个人观察和文献数据的分析，作者对导致开腹手术（中转）的腹腔镜胆囊切除术（LChE）失败的频率及原因进行了分析。233例手术中，217例LChE成功。16例患者（6.9%）进行了中转。根据关于150,000例LChE的文献汇总数据，中转频率为0.9%至18%。发现中转频率取决于确定LChE适应证的策略以及手术的技术维护水平。基于对4,98例LChE失败尝试的相关出版物分析和16例个人观察结果，确定了三组中转原因：病理形态学原因（393例，占78.9%；7例，占43.8%）；医源性原因（99例，占19.9%；7例，占43.8%）和技术器械性原因（6例，占1.2%；2例，占12.4%）。病理形态学原因导致非复杂性中转，提示LChE在具体患者中的应用受限。医源性和技术器械性原因突然出现，需要紧急开腹手术。因此，中转的总频率不能作为评估LChE术后并发症的标准。对中转开腹的原因进行专项分析并区分复杂性和非复杂性中转是适宜的。
