복강경 담낭 절제술 2,523예 시행 중 개복술로 전환한 111예에 대한 임상적 고찰Comparative Clinical Analysis of 111 Laparoscopic Cholecystectomy Cases Converted to Open Procedures
- Authors
- 방지성; 최유신; 김범규; 차성재; 지경천; 이정효; 장인택
- Issue Date
- 2008
- Publisher
- 한국간담췌외과학회
- Keywords
- Laparoscopic cholecystectomy; Conversion risk factors; 복강경 담낭 절제술; 전환 위험인자
- Citation
- 한국간담췌외과학회지, v.12, no.3, pp 168 - 172
- Pages
- 5
- Journal Title
- 한국간담췌외과학회지
- Volume
- 12
- Number
- 3
- Start Page
- 168
- End Page
- 172
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/31195
- ISSN
- 1226-4024
- Abstract
- Purpose: While laparoscopic cholecystectomy can be successfully performed in the majority of
patients, conversion to open procedure is still necessary in certain cases. The purpose of this
study was to identify the discerning factors that helped to predict the need for conversion to open
cholecystectomy.
Methods: A retrospective review was conducted on the data for 2,523 laparoscopic
cholecystectomies performed at Chung-Ang University Hospital between January 2002 and July
2007. Patient sex, age, height, weight, body mass index (BMI), duration of preoperative hospital
stay, preoperative physical examination, laboratory data, radiologic findings, and reasons for
conversion to open procedure were evaluated.
Results: Adhesion was perceived to be the most critical factor for conversion in 56 of 111 total
cases (50.5%). Bleeding (22.5%), bile duct injury (11.7%), inflammation (9.0%), and uncertain
anatomy (6.3%) followed sequentially in incidence. Factors found to significantly increase the
risk of conversion on univariate analysis were patient age >70 years, male sex, previous
abdominal operation, preoperative common bile duct stone, tenderness in the right upper
quadrant, distended shape of the gallbladder, and pericholecystic fluid collection. On multivariate
analysis, the following factors were found to be associated with a higher risk: patient age >70
years (p=0.002), male sex (p=0.012), previous abdominal operation (p<0.0001), and
preoperative common bile duct stone (p=0.041).
Conclusion: In the case of operations with such discerning factors, surgeons should be more
cautious and delicate in all procedures throughout the operative period. Furthermore, to reduce
the risk of additional severe complications, surgeons need to decide early on if they will perform
a conversion.
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