Difficult Situations in Laparoscopic Cholecystectomy: A Multicentric Retrospective Study
Difficult Situations in Laparoscopic Cholecystectomy: A Multicentric Retrospective Study
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DOI：
10.1097/sle.0b013e31829cebd8
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发表时间：
2014-12-01
影响因子：
1
通讯作者：
Dutta, Gautam
中科院分区：
文献类型：
--
作者：
Kala, Sanjay;Verma, Satyajeet;Dutta, Gautam
前言：困难的腹腔镜胆囊切除术(LC)是当今最常见的“困难”外科手术，它有可能将患者置于巨大的手术风险中。我们回顾了1995年6月至2011年12月在坎普尔LLR医院Mariampur和GSVM医学院两个大型中心收治的8347例LC患者的临床资料，并就困难情况下LC中转开腹手术的实际问题进行了讨论。结果：8347例患者中，2187例(26.2%)为困难患者。LC成功8265例，总完成率99.02%。在2187例疑难病例中，LC成功完成2105例(疑难病例完成率为96.25%)，中转开腹手术82例(疑难病例中转率3.75%)。结论：随着复杂胆囊镜手术经验和专业知识的增加，中转率呈下降趋势，许多疑难病例转而采用腹腔镜手术。然而，如果需要，为了患者的利益，转换不应被视为失败。
Introduction: Difficult laparoscopic cholecystectomy (LC) is the most common "difficult" surgical procedure performed today, which possesses the potential to place the patient at significant operative risk. We present our retrospective study and experience of 8347 patients with LC since June 1995 to December 2011 at 2 large centers: Mariampur and GSVM Medical College, LLR Hospital, Kanpur, with discussions regarding the practical aspects of LC in difficult situations with respect to conversion to open cholecystectomy.Methods: A retrospective analysis of patients who underwent LC from June 1995 to December 2011 was performed. The analysis was performed in relation to the need for conversion and the factors responsible for conversion.Results: Out of 8347 cases, 2187 cases (26.2%) were identified as difficult. LC was performed successfully in 8265 cases (total completion rate, 99.02%). Of the 2187 difficult cases, LC was completed successfully in 2105 cases (completion rate in difficult cases, 96.25%) and converted to open cholecystectomy in 82 cases (conversion rate in difficult cases, 3.75%).Conclusions: Because of the increasing exposure and expertise of surgeons dealing with complex gall bladder laparoscopies, rates of conversion to open cholecystectomy are decreasing and many difficult cases are now handled laparoscopically. However, if required, conversion should not be considered as a failure for the benefit of the patient.