Zehetner Jörg, Leidl Stefan, Wuttke Markus E, Wayand Wolfgang, Shamiyeh Andreas
Ludwig Boltzmann Institute for Operative Laparoscopy, 2nd Surgical Department, Academic Teaching Hospital, AKH Linz, Austria.
Surg Laparosc Endosc Percutan Tech. 2010 Jun;20(3):173-6. doi: 10.1097/SLE.0b013e3181df9dac.
Contraindications to laparoscopic cholecystectomy (LC) have diminished over the last decade but still conversion rate is about 5% to 6% in elective cases and higher in acute cholecystitis.
The aim of this study was to analyze whether the conversion rate is related to low (100 LC/y) versus high-volume hospitals (HVHs; >300 LC/y).
From 1999 to 2004, operations were performed in a low-volume hospital (LVH) and a HVH, divided into 3 groups: primary open cholecystectomy (OC), LC, and conversion (CC). These groups were analyzed with regard to indications, intraoperative findings, reason for conversion, and postoperative complications, and compared between the 2 hospitals.
In LVHs of the 550 patients who underwent cholecystectomy, 19 were OC (3.5%). Of the 531 patients who were started with laparoscopy, 5.3% (28 patients) were CC. In HVHs of the 1634 patients who underwent cholecystectomy, 82 were OC (5%). Of the 1552 patients who were started with laparoscopy, 5.8% (85 patients) were CC; P=0.7496. Dense adhesions (LVH 35.8% and HVH 37.6%, P=0.8544), severe cholecystitis (LVH 39.8% and HVH 34%, P=0.6199), and difficulties with the anatomy in Calot's triangle (LVH 7.2% and HVH 8.2%, P=0.8531) were the main reasons for conversion. There was no difference in the postoperative complication rate and reoperation rate between a LVH and a HVH.
There is no difference in conversion rate in LC in LVHs versus HVHs. The quality of LC and even CC is similar in LVH and HVH.
在过去十年中，腹腔镜胆囊切除术（LC）的禁忌证有所减少，但在择期手术中其转换率仍约为5%至6%，在急性胆囊炎中则更高。
本研究旨在分析转换率是否与低手术量医院（每年100例LC）和高手术量医院（HVHs；每年>300例LC）有关。
1999年至2004年期间，在一家低手术量医院（LVH）和一家HVH进行手术，分为3组：初次开腹胆囊切除术（OC）、LC和转换手术（CC）。对这些组进行了适应证、术中发现、转换原因和术后并发症的分析，并在两家医院之间进行了比较。
在接受胆囊切除术的550例患者的LVHs中，19例为OC（3.5%）。在开始进行腹腔镜检查的531例患者中，5.3%（28例患者）为CC。在接受胆囊切除术的1634例患者的HVHs中，82例为OC（5%）。在开始进行腹腔镜检查的1552例患者中，5.8%（85例患者）为CC；P = 0.7496。致密粘连（LVH为35.8%，HVH为37.6%，P = 0.8544）、严重胆囊炎（LVH为39.8%，HVH为34%，P = 0.6199）以及Calot三角区解剖困难（LVH为7.2%，HVH为8.2%，P = 0.8531）是转换的主要原因。LVH和HVH之间的术后并发症发生率和再次手术率没有差异。
LVHs与HVHs的LC转换率没有差异。LVH和HVH的LC甚至CC的质量相似。
