Early decision for conversion of laparoscopic to open cholecystectomy for treatment of acute cholecystitis
Early decision for conversion of laparoscopic to open cholecystectomy for treatment of acute cholecystitis
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DOI：
10.1016/s0002-9610(97)00005-6
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发表时间：
1997-06-01
影响因子：
3
通讯作者：
Wong, J
中科院分区：
文献类型：
--
作者：
Lo, CM;Fan, ST;Wong, J
背景：尽管最近的报道建议采用腹腔镜方法治疗急性胆囊炎，但其风险因素和失败的后果尚不清楚。方法：对557例腹腔镜胆囊切除术患者进行回顾性研究，找出70例（13%）经超声证实临床诊断为急性胆囊炎的患者。将需要转开腹手术的患者（转开腹组）与成功进行腹腔镜胆囊切除术的患者（转开腹组）进行比较。结果：70例患者中有8例（11%）需要转换。转换组有更多的老年人（小于或等于65岁）患者（88% vs 37%, P = 0.02），超声检查显示胆结石较大（25mm vs 15.5 mm, P = 0.03）。术前其他与严重炎症相关的因素无法预测。转换与术中发现的严重粘连有关，而与胆囊脓肿或坏疽性胆囊炎无关。中间腹腔镜手术时间为50分钟后进行转换。转换组需要更多的手术时间，更多的镇痛药，更长的恢复时间，更长的住院时间。术后并发症发生率明显高于对照组（63% vs 16%; P = 0.009）。结论：急性胆囊炎患者需要从腹腔镜转开腹胆囊切除术有术后并发症的风险。对于老年大胆结石患者，如果遇到严重粘连，外科医生应及早决定是否进行手术。(C) 1997年由摘录医学公司。
BACKGROUND: Although recent reports suggest an initial laparoscopic approach to acute cholecystitis, the risk factors and consequences of the failure of an attempt remained unknown.METHODS: A retrospective study of 557 laparoscopic cholecystectomies was undertaken to identify 70 patients (13%) with a clinical diagnosis of acute cholecystitis confirmed by ultrasonography. Patients who required conversion to laparotomy (conversion group) were compared to those with successful laparoscopic cholecystectomy (successful group).RESULTS: Eight of 70 patients (11%) required conversion. The conversion group had significantly more elderly (less than or equal to 65 years) patients (88% vs 37%; P = 0.02) and larger gallstones as shown on ultrasonography (25 mm vs 15.5 mm; P = 0.03). Other preoperative factors associated with severe inflammation were not predictive. Conversion was associated with the intraoperative finding of severe adhesions and not with those of empyema of gallbladder or gangrenous cholecystitis. Conversion was made after a median laparoscopic surgery time of 50 minutes. The conversion group required more operation time, more analgesics, a longer recovery time, and a longer hospital stay. In addition, the postoperative complication rate was significantly higher (63% vs 16%; P = 0.009).CONCLUSIONS: Patients who required conversion from laparoscopic to open cholecystectomy for acute cholecystitis are at risk for postoperative complications. In elderly patients with large gallstones, the surgeon should made an early decision to convert if severe adhesions are encountered. (C) 1997 by Excerpta Medica, Inc.