缝扎法腹腔镜胆囊切除术的临床研究  

Laparoscopic Cholecystectomy Performed by Suturing Method

作　　者：王绍勇[1] 戴德祥[1] 

机构地区：[1]成都铁路分局医院,四川成都610081

出　　处：《华西医学》2006年第4期691-692,共2页West China Medical Journal

摘　　要：目的：探讨缝扎法腹腔镜胆囊切除术（LC）的手术方法、适应证和临床应用价值。方法：全麻下采用缝扎法行LC，脐下缘皮肤戳第一孔（10mm）置入腹腔镜，剑突下2—5cm戳孔（10mm）为主操作孔，右锁骨中线肋缘下2-5cm戳孔（5mm）为辅助操作孔，右腋前线肋缘下2-5cm戳孔（5mm）为助手操作孔。借助腹腔镜弯钳和腹腔镜持针器4—0可吸收缝线腹腔内打外科结结扎和4—0可吸收缝针线缝扎双重处理胆囊管，打外科结结扎处理胆震动脉前分支，4—0可吸收缝针线缝扎处理胆囊动脉后分支。胆囊从剑突下孔或脐部孔取出。结果：237例中成功施行缝扎法LE226例（95％），中转钛夹法LC11例（5％）。25例Winslow孔附近放置多孔乳胶引流管，引流出淡血性渗出液20-200ml／d，术后1—3d拔除。无中转开腹，无严重的并发症，无死亡。手术历时20-90min，平均40min。术后住院2-6d。结论：只要选择合适的病例，施行缝扎法LC有效、安全、可行。此方法避免了钛夹和丝线的残留以及钛移位和游走所导致的并发症。Objective： In order to decrease the invasion and complications further, laparoscopic cholecystectomy （LC） with suturing method was used. Method： The first pert （diameter was 10mm） was punctured at the wrinkled skin near the navel for inserting laparoscope, the second port （10mm） was punctured below the xyphoid, the third pert （5mm） was punctured at right sid about 2 - 5cm at 2cm below arcus costarum at right midclavicular line, and the fourth pert （5mm） was punctured about at 2 - 5cm below arcus costarum at right anterioraxillar line. The gallbladder duct and artery were sutured or ligated with absorbable suture 4- 0 （pelyglycolic acid braided suture） by dissecting forceps and needle blocker, and the gallbladder was removed from the first pert or the second port. Results： LC of was performed in 226 patients by suturing method in 237 patients. The successful rate of operation was 95%, operative time was not extended, and the recovery was rapit. Conclusion： Suturing method was a secure and practicable method for LC. It could avoid the residual of silk and clips aftin the abdominal cavity and further decrease the invasion and complications.

关 键 词：LC 缝扎法 

分 类 号：R657.4[医药卫生—外科学]