探讨腹腔镜困难胆囊切除术中改行腹腔镜胆囊次全切除术（LSC）的临床疗效和安全性。

回顾性分析2011年1月至2016年11月在解放军413医院诊治的58例腹腔镜胆囊切除术（LC）术中改变术式患者临床资料。根据患者中转术式的不同，将患者分为LSC组和开腹胆囊切除术组（OC组）。其中LSC组31例，男13例，女18例；平均年龄（57±18）岁。OC组27例，男12例，女15例；年龄（54±16）岁。患者均签署知情同意书，符合医学伦理学规定。LSC组患者在腹腔镜下改为顺行或逆行切除胆囊，保留胆囊后壁。OC组采用右侧肋缘下斜切口行OC。术后对患者进行随访，两组患者手术时间、术中出血量、术后疼痛评分、引流管留置时间、住院时间比较采用t检验，术后并发症发生率比较采用χ²检验。

LSC组患者手术时间、术中出血量分别为（68±10）min、（56±11）ml，明显低于OC组的（89±13）min、（81±28）ml（t=-7.2，-4.5；P<0.05）。LSC组患者术后疼痛评分、引流管留置时间、住院时间分别为（3.1±0.8）分、（61±12）h、（4.8±1.8）d，明显低于OC组的（5.4±0.9）分、（73±14）h、（7.5±2.3）d（t=-10.3，-3.6，-5.0；P<0.05）。LSC组术后并发症发生率为10%（3/31），OC组为22%（6/27），差异无统计学意义（χ²=1.73，P>0.05）。两组患者术后均未发生死亡。

对于腹腔镜困难胆囊切除术患者，与OC相比，LSC的手术时间更短、术中出血量更少、手术安全性更高，有利于患者术后康复。

To evaluate the clinical efficacy and safety of laparoscopic subtotal cholecystectomy (LSC) in laparoscopic difficult cholecystectomy.

Clinical data of 58 patients who were converted to other operation procedure during laparoscopic cholecystectomy (LC) in No.413 Hospital of People's Liberation Army between January 2011 and November 2016 were analyzed retrospectively. According to different converted operation, the patients were divided into LSC group and open cholecystectomy group (OC group). There were 31 cases in LSC group, 13 males and 18 females, with an average age of (57±18) years and 27 in OC group, 12 males and 15 females, with an average age of (54±16) years. The informed consents of all patients were obtained and the local ethical committee approval was received. Patients in LSC group were converted to laparoscopic antegrade or retrograde cholecystectomy, and the posterior gallbladder wall was retained. Patients in OC group underwent OC through the right subcostal incision. All the patients were followed up after operation. The operation time, intraoperative bleeding volume, postoperative pain score, drainage duration and length of hospital stay in both groups were compared by t test, and the incidence of postoperative complications was compared by Chi-square test.

The operation time and intraoperative bleeding volume in LSC group were (68±10) min and (56±11) ml, significantly lower than (89±13) min and (81±28) ml in OC group (t= -7.2, -4.5; P<0.05). The postoperative pain score, drainage duration and length of hospital stay in LSC group were (3.1±0.8) min, (61±12) h and (4.8±1.8) d, significantly lower than (5.4±0.9) min, (73±14) h and (7.5±2.3) d in OC group (t=-10.3, -3.6, -5.0; P<0.05). The incidence of postoperative complications was 10%(3/31) in LSC group and 22%(6/27) in OC group, and no significant difference was observed (χ²=1.73, P>0.05). No postoperative death occurred in both groups.

For patients undergoing laparoscopic difficult cholecystectomy, compared with OC, LSC presents advantages of shorter operation time, less intraoperative bleeding volume and higher operation safety which are beneficial to the postoperative recovery of patients.