Materiale şi metode. S-au studiat 114 bolnavi operaţi laparoscopic sau prin conversie pentru CA. CA a fost stabilită conform
criteriilor Tokyo Guidelines. Bolnavii au fost stratificaţi în 2 loturi: I- CEL fără conversie şi II- CEL cu conversie. S-au analizat vîrstă,
sexul, rezultatele examinărilor clinico- paraclinice, inclusiv a raportului neutrofile/limfocite (RNL) ca marker al inflamaţiei. Dificultatea
intraoperatorie a CEL a fost apreciată conform scalei Parkland.
Rezultate. Rata de conversie a constituit 7,9% cazuri. În lotul cu conversie au predominat bărbaţii- 66,7%, în lotul fără conversie -
femeile (61,9%). Vârsta pacienţilor a fost semnificativ mai înaltă în cazul conversiei. În lotul cu conversie în 55,6% cazuri s-a iniţiat
CEL în termeni > de 72 ore de la debutul primelor manifestări clinice, în lotul fără conversie acest indice a constituit 27,6 %. În lotul I a
predominat gr.III de severitate intraoperatorie conform Parkland, în cazul conversiei gr.IV şi V. Cauzele conversiei: plastron inflamator
perivezicular şi al ligamentului hepato-duodenal (n=4), hemoragie intraoperatorie incontrolabilă laparoscopic (n=3), CA gangrenoasă
cu perforare şi abces perivezicular (n=2). RNL a fost semnificativ mai mare în lotul cu conversie (8,6), comparativ cu lotul fără
conversie (3,9).
Concluzii. Conversia CEL constituie o etapă raţională a tratamentului CA complicate. Factori predictivi ai conversiei au constituit sexul
masculin, vîrsta înaintată, adresarea tardivă. RNL poate fi util ca factor de pronostic în ce priveşte gradul de severitate al CA.
Aim of study. To study the risk factors of laparoscopic cholecystectomy (LC) conversion in patients with acute calculous cholecystitis
(AC).
Materials and methods. The 114 patients operated laparoscopically or by conversion for CA were studied. AC was established
according to Tokyo Guidelines criteria. The patients were stratified into 2 groups: I- LC without conversion and II- LC with conversion.
Age, sex, the results of clinical-paraclinical examinations, including the neutrophil/lymphocyte ratio (NLR) as a marker of inflammation,
were analyzed. The intraoperative difficulty of LC was assessed according to the Parkland scale.
Results. The conversion rate constituted 7.9% of cases. In the group with conversion, men predominated - 66.7%, in the group without
conversion - women (61.9%). The age of the patients was significantly higher in the case of conversion. In the group with conversion
in 55.6% of cases, LC was initiated within > 72 hours from the onset of the first clinical manifestations, in the group without conversion
this index was 27.6%. In group I, grade III of intraoperative severity according to Parkland prevailed, in the case of conversion prevailed grade IV and V. The causes of conversion were: perivesicular inflammatory and hepato-duodenal ligament plastron (n=4),
laparoscopic uncontrollable intraoperative hemorrhage (n=3), gangrenous AC with perforation and perivesicular abscess (n=2). NLR
was significantly higher in the conversion group (8.6) compared to the non-conversion group (3.9).
Conclusions. LC conversion is a rational step in the treatment of complicated AC. Predictive factors of conversion were male sex,
advanced age, late addressing. NLR may be useful as a prognostic factor regarding the severity of AC.
