| ObjectivesTo research the independent risk factors leading to the conversion to open surgery during laparoscopic cholecystectomy,in order to cause hepatobiliary surgeons to have a comprehensive and in-depth understanding of the conversion to open surgery during laparoscopic cholecystectomy.It can effectively control and avoid the independent risk factors,reduce the possibility of conversion to laparotomy in laparoscopic cholecystectomy to a certain extent,increase the success rate of laparoscopic surgery,so as to reduce the pain of operation and improve the quality of medical treatment.MethodsFrom September 2016 to September 2018,648 patients underwent cholecystectomy in the hepatobiliary surgery department of Hebei Provincial people’s Hospital.The differences between laparoscopic cholecystectomy and laparoscopic to open cholecystectomy were analyzed retrospectively.In order to find out the independent risk factors of laparoscopic cholecystectomy to open operation,the related clinical factors were discussed deeply.ResultsA total of 648 cases underwent cholecystectomy,of which 623 cases(96.4%)underwent laparoscopic cholecystectomy,113 cases(18.1%)underwent laparoscopic cholecystectomy.229 cases(36.8%)and 281 cases(45.1%)were performed in the title of deputy chief physician.25 cases(3.6%)were converted to open surgery during laparoscopic cholecystectomy,2 cases(8%)were converted to open surgery in the title of primary physician.Among them,6 cases(24%)were converted to open surgery,17 cases(68%)were converted to open surgery during the operation of the title of deputy chief physician,and the rate of conversion to open surgery was 24%,and 17 cases(68%)were converted to open surgery during the operation of the title of deputy chief physician.There were 19 cases(2.9%,76%)with local difficult anatomy caused by gallbladder triangle and its surrounding adhesion during the conversion to open cholecystectomy.The amount of local hemorrhage caused by the injury of the gallbladder artery was large.Three patients(0.46%,12%)were converted to open surgery due to unclear visual field of operation,and one patient(0.15%,4%)had difficulty in operation caused by visceral inversion,and there were 3 cases(0.46%)and 1 case(0.15%)with difficulty in operation due to the conversion to laparotomy due to the unclear visual field of the operation,which accounted for 0.46%and 12%respectively.One patient(0.15%,4%)suffered from small diameter of gallbladder duct and inadequate exposure of gallbladder duct.One patient with Mirrizi syndrome(0.15%,4%)was found.Univariate analysis showed that coronary heart disease or arrhythmia,neutrophil count>6.3×10~9/L,glutamic pyruvic transaminase>40 U/L,plasma albumin<40 g/L,gallbladder wall thickness>3 mm,and multiple gallstones were found.The operation time was 5-10 days,complicated with choledocholithiasis,gallbladder wall suppuration,gallbladder wall gangrene,gallbladder wall edema,gallbladder wall perforation,gallbladder artery hemorrhage,severe adhesion of the gallbladder,and unclear anatomy around the gallbladder.The highest body temperature>37.3℃,the width of common bile duct>6mm and bleeding were significantly different between the open group and cholecystectomy group 5 days before operation(P<0.05).The results showed that there was no significant difference between the two groups(P<0.05).During laparoscopic cholecystectomy,the professional titles of the patients were different,but there was no significant difference between them(P>0.05).Multivariate analysis showed that adhesion around gallbladder,unclear anatomy around gallbladder,hemorrhage of gallbladder artery,widening of common bile duct,coronary heart disease or arrhythmia were independent risk factors of laparoscopic cholecystectomy(P<0.05,OR>1);Conclusions 1 The results showed that the independent risk factors during laparoscopic cholecystectomy were severe adhesion of gallbladder,unclear anatomy around gallbladder,hemorrhage of gallbladder artery,Common bile duct width>6mm,coronary heart disease or arrhythmia.2 During the course of laparoscopic cholecystectomy,all the surgeonspassed the“learning curve”,there was no significant difference in the proportion of laparoscopic cholecystectomy to open cholecystectomy,The professional title was not an independent risk factor in laparoscopic cholecystectomy.3 The operator should have a comprehensive understanding of theindependent risk factors affecting laparoscopic gallbladder resection,reasonable evaluation before operation,purposeful avoidance of independent risk factors,careful operation during operation,and reduction of conversion to laparotomy.Figure 4;Table 8;Reference 110... |
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