Slim K, Pezet D, Riff Y, Clark E, Chipponi J
Service de Chirurgie Generale et Digestive, Hotel-Dieu, Clermont-Ferrand, France.
Br J Surg. 1995 Oct;82(10):1406-8. doi: 10.1002/bjs.1800821036.
Sixteen of 65 laparoscopically assisted colorectal operations were converted to an open procedure, usually because of dissection difficulties. Conversion was decided early in the procedure in four cases without perioperative morbidity and later in 12 cases, after a mean of 56 min. The results in patients undergoing converted operation were compared with those in 252 having a planned open colorectal procedure during the same period. The groups were comparable with regard to age, health status, factors influencing intestinal healing and grade of surgeon. A higher postoperative morbidity rate (50 versus 21 per cent) and more anastomotic leakages (25 versus 8 per cent) were apparent in the converted group. Operating time, postoperative ileus and hospital stay were longer in those requiring a converted operation. These poor results suggest that careful preoperative patient selection for laparoscopic procedures and a rapid decision to convert in case of difficulty are important.
65例腹腔镜辅助结直肠手术中有16例转为开放手术，通常是由于解剖困难。4例在手术早期决定转为开放手术，未出现围手术期并发症，12例在平均56分钟后于手术后期决定转为开放手术。将转为开放手术患者的结果与同期252例行计划性开放结直肠手术患者的结果进行比较。两组在年龄、健康状况、影响肠道愈合的因素和外科医生级别方面具有可比性。转为开放手术组术后发病率较高（50%对21%），吻合口漏更多（25%对8%）。需要转为开放手术的患者手术时间、术后肠梗阻和住院时间更长。这些不良结果表明，对腹腔镜手术进行仔细的术前患者选择以及在遇到困难时迅速决定转为开放手术很重要。
