Bahten Luiz Carlos Von, Isa Ana Cristina, Figueiredo Pâmela Conceição, Campezato Hugo, Isa Rosana Hapsi, Olandoski Márcia
Serviço de Cirurgia Geral Hospital Universitário Cajuru, BR.
Rev Col Bras Cir. 2009 Apr;36(2):135-8.
To analyze the rate and main causes for conversion to open surgery among acute and chronic cholecystitis.
A retrospective analysis of 1359 patient medical charts submitted to cholecystectomy in hospitalUniversitário Cajuru's general surgery department was done during the period from january 2000 to october 2006.
One thousand and sixty six laparoscopic cholecystectomies were performed, 701 (65.75%) due to chronic cholecystolithiasis, 356 (33.39%) due to acute cholecystolithiasis, seven (0.65%) had gallbladder polyps and two (0.21%) cases had hydropic gallbladder. The conversion rate in acute cases was 7.86%, and in chronic cases were 2.85% (p=0.0003). The average age for conversion was 50.96 +/- 17.49 years-old for acute cases and 56.45 +/- 12.28 years-old for chronic cases. The operative meantime was 152.5 minutes (30 - 36) for acute and 157.5 minutes (90 - 240) for chronic cholecystolithiasis (p=0.959). The conversion reasons for chronic cholecystolithiasis were: obscure anatomy in 16 cases (80%) and adhesions in 14 cases (70%), considering that in ten cases both causes were associated. For acute presentation, conversions were due to adhesions in 13 (46.42%) patients and technical difficulties were found in 8 (28.57%) patients (p=0.008).
The rate for conversion of laparoscopic cholecystectomy to open surgery is higher in acute cholecystolithiasis when in comparison to chronic ones. Both, the presence of adhesions in acute cases, and difficult anatomy identification in chronic cases, were the most common reasons to impair the laparoscopic procedures performance in our department.
分析急性和慢性胆囊炎中转开腹手术的发生率及主要原因。
对2000年1月至2006年10月期间提交至卡茹鲁大学医院普通外科进行胆囊切除术的1359例患者病历进行回顾性分析。
共进行了1066例腹腔镜胆囊切除术，其中701例（65.75%）因慢性胆囊结石，356例（33.39%）因急性胆囊结石，7例（0.65%）有胆囊息肉，2例（0.21%）有胆囊积水。急性病例中转开腹手术的发生率为7.86%，慢性病例为2.85%（p = 0.0003）。急性病例中转开腹手术患者的平均年龄为50.96±17.49岁，慢性病例为56.45±12.28岁。急性胆囊结石手术的平均时长为152.5分钟（30 - 36分钟），慢性胆囊结石手术为157.5分钟（90 - 240分钟）（p = 0.959）。慢性胆囊结石中转开腹手术的原因包括：16例（80%）解剖结构不清，14例（70%）有粘连，其中10例两种原因并存。急性胆囊炎中转开腹手术的原因包括：13例（46.42%）有粘连，8例（28.57%）存在技术困难（p = 0.008）。
与慢性胆囊结石相比，急性胆囊结石腹腔镜胆囊切除术中转开腹手术的发生率更高。急性病例中的粘连以及慢性病例中解剖结构难以辨认是导致本科室腹腔镜手术操作困难的最常见原因。
