Ercan Metin, Bostanci Erdal Birol, Ulas Murat, Ozer Ilter, Ozogul Yusuf, Seven Canbek, Atalay Fuat, Akoglu Musa
Department of Gastroenterological Surgery, Turkiye Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.
Surg Laparosc Endosc Percutan Tech. 2009 Oct;19(5):373-8. doi: 10.1097/SLE.0b013e3181b92935.
For laparoscopic cholecystectomy, previous abdominal operations are seen as a relative contraindication. The purpose of this study was to investigate the effects of the incision type of previous abdominal surgery on laparoscopic cholecystectomy in terms of complications and conversion to open surgery. Data from 677 patients who had previously undergone abdominal surgery before undergoing laparoscopic cholecystectomy were prospectively collected and evaluated. From the previous operations, the incisions were upper abdominal in 66 patients, lower abdominal in 567, and upper plus lower in 44. Conversion rates in the upper, lower and upper plus lower groups were 27.27%, 2.82%, and 25%, respectively. Intraoperative major complications were bile duct injury (1 patient, upper plus lower incision group), small bowel mesentery injury, and aortic injury (1 patient each, both in the lower incision group). Postoperative major intra-abdominal complications were duodenal injury (1 patient, upper incision group) and small intestine injury (1 patient, lower incision group). The lower abdominal incision group had fewer adhesions in the upper abdomen than did the other 2 groups, and as a result had a much lower conversion rate.
对于腹腔镜胆囊切除术而言，既往腹部手术被视为相对禁忌证。本研究的目的是从并发症及中转开腹手术方面，探讨既往腹部手术的切口类型对腹腔镜胆囊切除术的影响。前瞻性收集并评估了677例在接受腹腔镜胆囊切除术之前曾接受过腹部手术患者的数据。在既往手术中，66例患者的切口位于上腹部，567例位于下腹部，44例为上腹部加下腹部。上腹部、下腹部及上腹部加下腹部组的中转率分别为27.27%、2.82%和25%。术中主要并发症包括胆管损伤（1例，上腹部加下腹部切口组）、小肠系膜损伤和主动脉损伤（各1例，均在下腹部切口组）。术后主要腹腔内并发症包括十二指肠损伤（1例，上腹部切口组）和小肠损伤（1例，下腹部切口组）。下腹部切口组上腹部的粘连比其他两组少，因此中转率低得多。
