胃切除术后腹腔镜胆囊切除术的转换：一项15年的回顾。
Conversion in laparoscopic cholecystectomy after gastric resection: a 15-year review.
作者信息
Fraser Shannon A, Sigman Harvey
机构信息
Department of Surgery, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montréal, Que.
出版信息
Can J Surg. 2009 Dec;52(6):463-6.
BACKGROUND
Gastrectomy or truncal vagotomy is known to increase the incidence of cholelithiasis. Many of these patients will become symptomatic, and the adhesions from their gastric resection may make laparoscopic cholecystectomy much more difficult.
METHODS
We prospectively assessed the data for the 15-year cumulative laparoscopic cholecystectomy experience of 1 surgeon at a university teaching hospital with respect to conversion and postoperative outcomes, with particular attention to patients having had previous gastric resections.
RESULTS
Patients with previous gastrectomies had similar operative times (mean 81.1, range 45-120 min), a higher conversion rate (64.2%) and a higher complication rate (35.7%) than those who had had other previous upper abdominal surgeries (mean 73.2, range 35-130 min, conversion 25% and complication 11.3%) and those without previous abdominal surgeries (mean 66.5, range 25-250 min, conversion 2.7% and complication 4.5%).
CONCLUSION
Preoperative knowledge of the increased conversion rate and increased morbidity will inform surgical planning for both the surgeon and the patient.
背景
已知胃切除术或迷走神经干切断术会增加胆结石的发病率。这些患者中的许多人会出现症状，并且胃切除术后的粘连可能会使腹腔镜胆囊切除术变得更加困难。
方法
我们前瞻性地评估了一名外科医生在一所大学教学医院15年的腹腔镜胆囊切除术累积经验数据，涉及中转情况和术后结果，尤其关注曾接受过胃切除术的患者。
结果
与曾接受过其他上腹部手术的患者（平均73.2分钟，范围35 - 130分钟，中转率25%，并发症率11.3%）以及未接受过腹部手术的患者（平均66.5分钟，范围25 - 250分钟，中转率2.7%，并发症率4.5%）相比，曾接受过胃切除术的患者手术时间相似（平均81.1分钟，范围45 - 120分钟），中转率更高（64.2%），并发症率更高（35.7%）。
结论
术前了解中转率增加和发病率增加的情况，将为外科医生和患者的手术规划提供参考。
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