摘要
目的探讨困难腹腔镜胆囊切除术(Laparoscopic cholecystectomy,LC)的处理。方法总结分析2000年1月—2012年2月226例困难LC的临床资料,探讨降低中转开腹率及减少手术并发症的方法。结果胆囊颈部和胆囊管结石嵌顿125例,胆囊炎急性发作致胆囊三角解剖关系不清71例,萎缩性结石性胆囊炎30例。中转开腹23例,其中胆囊三角解剖不清无法分离显露10例;急性胆囊炎,胆囊与周围组织致密黏连,无法分离显露胆囊6例;胆囊萎缩、胆囊三角纤维化无解剖层次5例;胆囊床渗血不止2例。术后胆漏2例,经引流胆漏停止10 d后拔除引流管。226例住院时间5～13 d,平均7 d。182例随访3～12个月,无胆道损伤发生。有1例术后2周再次出现腹痛经磁共振检查(MRCP)胆囊管与胆总管汇合位置较低且汇合处胆囊管残留结石嵌顿,经开腹手术取出结石。结论困难LC,术中充分细致解剖、严密止血、镜下缝合等方法,大多可以安全完成。但对认为不安全的LC及时中转为开腹胆囊切除术,有利于减少或避免并发症的发生。
Objective To discuss the difficuh laparoscopic cholecystectomy （Laparoscopic cholecystectomy, LC） treatment. Methods To analyze the clinical data from 226 cases of difficult LC from January 2000 to February 2012 ,in order to lower the rate of laparotomy and to reduce operation complications. Results The sample includes 125 cases of the calculus incarceration in the neck of the gallbladder and the cystic duct,71 cases of unclear relationship of Calot＇ s triangle relations in anatomy caused by acute cholecystitis,30 cases of a-trophic calculous cholecystitis. There are totally 23 cases of conversion to laparotomy. Among them ,there are 10 cases failing in separation or revelation caused by unclear Calot＇ s triangle in anatomy,6 cases failing in seParation or revelation caused by adhesion of gallbladder and the surrounding tissue in acute cholecystitis,5 cases without anatomical level caused by atrophy of gallbladder or gallbladder triangle fibrosis,2 cases with continual bleeding in the gallbladder bed. There are 2 cases with postoperative bile leakage,in which the dreainage tubes were removed 10 days after the cease of leakage with the treatment of the drainage. The time in hospital ranges from 5 to 13 days in these 226 cases while the average time is 7 days. There are 182 cages without biliary injury according to 3 to 12 months follow-up. In one case, there is recurrence of abdominal pain. Magnetic resonance imaging（MRCP） check indicates a low confluence position of cystic duct and common bile duct in addition to remnant calculus in the confluence of cholecystic duct. The calculus has been removed with laparoto-my. Conclusion Most difficult LC can be successful with careful anatomy, strict hemostasis, suture under microscope. But unsafe LC should be converted timely to cholecystectomy with laparotomy,which can reduce or avoid complications.
出处
《安徽医药》
CAS
2013年第9期1527-1529,共3页
Anhui Medical and Pharmaceutical Journal
关键词
困难胆囊切除术
腹腔镜
胆囊结石
difficult cholecystectomy
laparoscope
gallbladder calculus
