Objective To investigate the causes and prevention of conversion to laparotomy during laparoscopic cholecystectomy. Methods Clinical data of 30 out of 770 patients converting to laparotomy during laparoscopic cholecystectomy in Guangdong Chaozhou Central Hospital from February 2007 to January 2013 were analyzed retrospectively. There were 13 males and 17 females with age ranging from 25 to 81 years old and a median age of 48 years old. The informed consents of all patients were obtained and the ethical committee approval was received. Laparoscopic cholecystectomy was performed in the patients under endotracheal general anesthesia using the conventional 4-port approach. The causes of conversion to laparotomy during laparoscopic cholecystectomy and the incidence of postoperative complications of the patients were observed. Results The incidence of conversion to laparotomy during laparoscopic cholecystectomy was 3.9%(30/770). The causes of conversion to laparotomy were adhesion at Calot's triangle (n=12), gallbladder bed bleeding (n=6), gallbladder artery bleeding (n=4), dense adhesion around the gallbladder with difficult dissecting (n=4), dissatisfactory treatment of the gallbladder stump (n=1), liver surface laceration (n=1), gallbladder carcinoma (n=1). All the converted laparotomies were completed at one time. No complication was observed in all patients after operation. Conclusions The common causes for conversion to laparotomy during laparoscopic
cholecystectomy were unclear dissection at Calot's triangle and around the gallbladder, gallbladder bed or gallbladder artery bleeding, dissatisfactory treatment of gallbladder stump, liver surface laceration, gallbladder cancer, etc. Improving the preoperative evaluation, intraoperative appropriate treatment of the Calot's triangle and gallbladder bed are the keys to prevent conversion to laparotomy during laparoscopic cholecystectomy.

Objective:To investigate the clinical effect on ultrasound-guided vascular access-interventional therapy of hemodialysis in day surgery mode.Methods:Hemodialysis patients with vascular access dysfunction who underwent ultrasound-guided interventional therapy in the First Affiliated Hospital of Xi'an Jiaotong University from September 1, 2018 to October 31, 2020 were retrospectively analyzed. Demographic and clinical data were collected by electronic medical record system and telephone follow-up. Kaplan-Meier method was used to analyze the patency rate of vascular access.Results:A total of 421 cases of ultrasound-guided vascular access intervention were performed in 269 patients. The technical success rates of stenosis, chronic occlusion and acute occlusion lesion were 98.8%, 90.6% and 86.4%, respectively, and 406 cases (96.4%) of 246 patients were clinically successful. The postoperative brachial artery blood flow was 821(627, 1 029) ml/min, which was significantly higher than 309(202, 453) ml/min before the operation ( Z=-13.547, P<0.001). No serious complications occurred during and after the operation. At 6, 12, 18 and 24 months after operation, the primary patency rate was 74%, 59%, 48% and 45%, respectively, the assisted primary patency rate was 94%, 91%, 88% and 82%, and the secondary patency rate was 96%, 93%, 91% and 86%. Compared with the conventional inpatient surgery mode, the total cost of the day surgery mode was significantly reduced [12 067(10 051, 13 198) yuan vs 14 986(12 411, 20 643) yuan, Z=-13.185, P<0.001], and the hospital stay was significantly shortened [5.1(3.5, 6.9) h vs 73.4(31.6, 146.6) h, Z=-13.348, P<0.001]. Conclusion:It is safe and effective to perform interventional therapy for vascular access malfunction under ultrasound in day surgery mode, which can save cost and time of hospitalization, and can be carried out in hospitals with relevant conditions.