Schrenk P, Woisetschläger R, Wayand W U
Second Surgical Unit, AKH Linz, Austria.
Surg Endosc. 1995 Jan;9(1):25-8. doi: 10.1007/BF00187880.
In 1,300 patients undergoing laparoscopic cholecystectomy (LC) 56 patients (4.3%) required conversion to open cholecystectomy (OC); 41 (73%) of the conversions were elective, whereas 15 (27%) were enforced. The causes of the 56 conversions are described and analyzed. Logistic regression analysis of 23 parameters identified the following data as associated with a higher risk for conversion: pain or rigidity in the right upper abdomen (P < 0.01), thickening of the gallbladder wall on preoperative ultrasound (P < 0.05), intraoperatively found dense adhesions to the gallbladder or in Calot's triangle (P < 0.001), and intraoperatively found acute inflammation of the gallbladder (P < 0.01). Clinical findings of an acute cholecystitis associated with intraoperative dense scarring in Calot's triangle were the best factors predicting conversion from LC to OC. As a result of the study we preoperatively select our patients for either LC or OC, and a difficult case is performed by a more experienced surgeon to keep conversion rate and complications low.
在1300例行腹腔镜胆囊切除术（LC）的患者中，56例（4.3%）需要转为开腹胆囊切除术（OC）；其中41例（73%）的转为开腹手术是选择性的，而15例（27%）是被迫的。对这56例转为开腹手术的原因进行了描述和分析。对23项参数进行逻辑回归分析后发现，以下数据与更高的转为开腹手术风险相关：右上腹疼痛或僵硬（P<0.01）、术前超声显示胆囊壁增厚（P<0.05）、术中发现胆囊或胆囊三角区有致密粘连（P<0.001）以及术中发现胆囊急性炎症（P<0.01）。与术中胆囊三角区致密瘢痕形成相关的急性胆囊炎的临床发现是预测从LC转为OC的最佳因素。作为该研究的结果，我们在术前为患者选择行LC或OC手术，对于困难病例由经验更丰富的外科医生进行操作，以降低转为开腹手术率和并发症发生率。
