腹腔镜顺逆结合胆囊切除术预防胆管损伤的临床分析  

Clinical analysis of combined antegrade and retrograde technique of laparoscopic cholecystectomy in prevention of bile duct injury

作　　者：杨浩雷 保红平 姚永良 李奎 高瑞岗 方登华 

机构地区：[1]云南省曲靖市第二人民医院普通外科,云南曲靖655000

出　　处：《中国普通外科杂志》2006年第8期576-578,共3页China Journal of General Surgery

摘　　要：目的探讨腹腔镜顺逆结合胆囊切除术预防胆管损伤并发症的临床价值。方法回顾性分析1 9 9 1年3月—2 0 0 6年6月间腹腔镜顺逆结合胆囊切除术6 1 3例的临床资料。结果6 1 3例中胆囊结石伴胆囊萎缩1 2 1例,急性、亚急性胆囊炎4 3 2例,胆囊结石伴慢性胆囊炎4 2例,胆囊息肉1 8例。中转开腹9例,(5例为胆囊结石伴胆囊萎缩,4例亚急性胆囊炎)。平均手术时间4 3.5 m in,术后仅1例发生毛细胆管漏,经引流3 d痊愈,其余患者均顺利恢复,无胆管损伤病例,无出血、感染及死亡等严重并发症发生。平均术后住院日5.5 d。结论腹腔镜顺逆结合胆囊切除术能提高腹腔镜胆囊切除术的成功率,减少了腹腔镜胆囊切除术胆管损伤并发症的发生,特别是Calot三角解剖不清或变异时,此手术方法更有效。Objective To discuss the clinical value laparoscopic cholecystectomy in prevention of bile duct of combined antegrade and retrograde technique of injury. Methods Clinical data of 613 patients who underwent laparoscopic cholecystectomy with combined antegrade and retrograde technique from March 1991 to June 2006 were analyzed retrospectively. Results Cholecystolithiasis with atrophy of gallbladder was found in 121 cases, acute and subacute cholecystitis in 432 cases, cholecystolithiasis with chronic cholecystitis in 42 cases and polyps of cholecyst in 18 cases. Nine cases were converted to laparotomy （5 cases of cholecystolithiasis with atrophy of gallbladder and 4 cases of subacute cholecystitis ）. The average operation time was 43.5 minutes. Bile leakage occured in only 1 case after operation and fully recovered after 3 days of drainage, and all the other cases had smooth recovery with no bile duct injuries or serious complications such as haemorrhage, infection or death. The mean hospitalization time after operation was 5. 5 days. Conclusions The application of combined antegrade and retrograde technique can increase the success rate of laparoscopic cholecystectomy, and reduce the incidence of injuries of bile duct, especially in those patients with inadequate exposure or anatomical variation of Calot＇s triangle.

关 键 词：胆囊切除术 腹腔镜 胆管/损伤 

分 类 号：R657.4[医药卫生—外科学]