Department of Surgery, School of Medicine, Ankara University, Ankara, Turkey.
Clinics (Sao Paulo). 2011;66(3):417-20. doi: 10.1590/s1807-59322011000300009.
Laparoscopic cholecystectomy (LC) has become the gold standard for the surgical treatment of gallbladder disease, but conversion to open cholecystectomy is still inevitable in certain cases. Knowledge of the rate and impact of the underlying reasons for conversion could help surgeons during preoperative assessment and improve the informed consent of patients. We decided to review the rate and causes of conversion from laparoscopic to open cholecystectomy.
This study included all laparoscopic cholecystectomies due to gallstone disease undertaken from May 1999 to June 2010. The exclusion criteria were malignancy and/or existence of gallbladder polyps detected pathologically. Patient demographics, indications for cholecystectomy, concomitant diseases, and histories of previous abdominal surgery were collected. The rate of conversion to open cholecystectomy, the underlying reasons for conversion, and postoperative complications were also analyzed.
Of 5382 patients for whom LC was attempted, 5164 were included this study. The overall rate of conversion to open cholecystectomy was 3.16% (163 patients). There were 84 male and 79 female patients; the mean age was 52.04 years (range: 26-85). The conversion rates in male and female patients were 5.6% and 2.2%, respectively (p < 0.001). The most common reasons for conversion were severe adhesions caused by tissue inflammation (97 patients) and fibrosis of Calot's triangle (12 patients). The overall postoperative morbidity rate was found to be 16.3% in patients who were converted to open surgery.
Male gender was found to be the only statistically significant risk factor for conversion in our series. LC can be safely performed with a conversion rate of less than 5% in all patient groups.
腹腔镜胆囊切除术（LC）已成为胆囊疾病手术治疗的金标准，但在某些情况下仍不可避免地需要转为开腹胆囊切除术。了解导致中转的原因及其发生率有助于外科医生在术前评估，并提高患者的知情同意率。我们决定回顾腹腔镜转为开腹胆囊切除术的发生率和原因。
本研究纳入了 1999 年 5 月至 2010 年 6 月期间因胆囊结石行腹腔镜胆囊切除术的所有患者。排除标准为恶性肿瘤和/或病理检查发现胆囊息肉。收集患者的人口统计学资料、胆囊切除术的适应证、并存疾病和既往腹部手术史。分析中转开腹胆囊切除术的发生率、中转原因和术后并发症。
在 5382 例尝试行 LC 的患者中，有 5164 例纳入本研究。中转开腹胆囊切除术的总体发生率为 3.16%（163 例）。其中男 84 例，女 79 例；平均年龄 52.04 岁（26-85 岁）。男性和女性患者的中转率分别为 5.6%和 2.2%（p<0.001）。中转的最常见原因是组织炎症引起的严重粘连（97 例）和 Calot 三角纤维化（12 例）。中转开腹的患者术后总并发症发生率为 16.3%。
在我们的研究中，男性是唯一具有统计学意义的中转危险因素。LC 可以安全进行，所有患者组的中转率均低于 5%。
