背景:由于胆囊穿孔的高发病率和高死亡率,因此对外科医生来说具有挑战性。稀有,和手术方法。腹腔镜胆囊切除术(LC)现在与开腹胆囊切除术一起用于治疗胆囊穿孔。本研究旨在根据改良的Niemeier分类评估I型胆囊穿孔患者从腹腔镜到开腹胆囊切除术的影响因素。
方法:将符合纳入标准的患者分为两组:LC和转换为开腹胆囊切除术(COC)。人口统计,临床,放射学,术中,并对术后因素进行组间比较。
结果:本研究包括42名符合纳入标准的患者,其中28人在LC组,14人在COC组。他们的平均年龄为68(55-85)岁。两组之间的年龄没有显着差异(p=0.218)。然而,组间性别分布存在显著差异(p=0.025).组间穿孔的位置显著不同(p<0.001)。在LC组中,22例患者从眼底穿孔,四个从后备箱,脖子上还有两个.在COC组中,两名患者从眼底穿孔,四个从后备箱,脖子上有八个。LC(105.0分钟[60-225])和COC(125.0分钟[110-180])组之间的外科手术时间显着不同(p=0.035)。初级外科医生的年龄在LC(42岁[34-63])和COC(55岁[36-59])组之间也存在显着差异(p=0.001)。
结论:对于改良的NiemeierI型胆囊穿孔,可以安全地进行LC。穿孔部位与Calot三角形的接近度,Charlson合并症指数(CCI),和东京分类是影响腹腔镜胆囊穿孔手术转换为开腹手术的因素。
BACKGROUND: Gallbladder perforations are challenging to manage for surgeons due to their high morbidity and mortality, rarity, and surgical approach. Laparoscopic cholecystectomy (LC) is now included with open cholecystectomy in surgical managing gallbladder perforations. This study aimed to evaluate the factors affecting conversion from laparoscopic to open cholecystectomy in cases of type I gallbladder perforation according to the Modified Niemeier classification.
METHODS: Patients who met the inclusion criteria were divided into two groups: LC and conversion to open cholecystectomy (COC). Demographic, clinical, radiologic, intraoperative, and postoperative factors were compared between groups.
RESULTS: This study included 42 patients who met the inclusion criteria, of which 28 were in the LC group and 14 were in the COC group. Their median age was 68 (55-85) years. Age did not differ significantly between groups (p = 0.218). However, the sex distribution did differ significantly between groups (p = 0.025). The location of the perforation differed significantly between groups (p < 0.001). In the LC group, 22 patients were perforated from the fundus, four from the trunk, and two from the neck. In the COC group, two patients were perforated from the fundus, four from the trunk, and eight from the neck. Surgical procedure times differed significantly between the LC (105.0 min [60-225]) and COC (125.0 min [110-180]) groups (p = 0.035). The age of the primary surgeons also differed significantly between the LC (42 years [34-63]) and COC (55 years [36-59]) groups (p = 0.001).
CONCLUSIONS: LC can be safely performed for modified Niemeier type I gallbladder perforations. The proximity of the perforation site to Calot\'s triangle, Charlson comorbidity index (CCI), and Tokyo classification are factors affecting conversion from laparoscopic to open surgery of gallbladder perforations.