腹腔镜胆囊切除术580例临床经验总结  

Selection of operating method during laparoscopic cholecystectomy:experiences of 580 cases

作　　者：周伟[1] 

机构地区：[1]中日友好医院普外科,北京100029

出　　处：《中日友好医院学报》2010年第2期71-74,93,共5页Journal of China-Japan Friendship Hospital

摘　　要：目的:提高腹腔镜胆囊切除术(LC)的安全性,降低LC胆管、血管和内脏损伤的发生率。方法:回顾分析2005年12月～2008年11月间580例LC患者的临床资料,根据术中情况采用顺行切除439例(76%)、顺行和逆行结合切除(顺逆结合)125例(21%)、逆行切除16例(3%)。结果:本组LC成功率99.5%,3例(0.5%)中转开腹,其中2例为萎缩性结石性胆囊炎与十二指肠、胃、横结肠、肝十二指肠韧带冰冻性粘连,1例为慢性炎症产生的门静脉侧支损伤大出血。胆囊完全切除569例(98%),大部切除11例(2%);手术并发症3例(0.5%),其中肝总管灼伤致胆漏1例,门静脉侧支损伤致大出血1例,十二指肠损伤1例。结论:LC应根据术中情况采取顺行切除、逆行切除或顺逆结合的方法,当粘连严重不能安全分离时应采取胆囊大部切除或主动中转开腹手术。Objective：To increase the safety of laparoscopic cholecystectomy（LC）and decrease the injury rate of the bile duct,vessels or viscera.Methods：A retrospectively analysis in 580 cases of LC during Dec.2005 to Nov.2008 was done.According to the operative condition,antegrade dissection（AD）,antegrade-retrograde dissection（ARD）or retrograde dissection（RD）were performed and the number of each was 439（76%）,125（21%）and 16（3%）respectively.Results：The rate of success was 99.5%.The rate of conversion to laparotomy was 0.5%（3/580）,2 of them were due to the strong adhesion between the atropic gallbladder and the surrounding duodenum,stomach,transverse colon and hepatoduodenal ligment.One was due to massive hemorrhage because of injury of collateral of portal vein.The total resection was 569 cases（98%）and the partial resection was 11 cases（2%）.There were 3 complications including biliary fistula by burns of common hepatic duct（1 case）,injury of collateral of portal vein（1 case）and injury of duodenum（1 case）.Conclusion：According to the intraoperative condition of LC,the operator could choose AD,ARD or RD.Subtotal cholecystectomy or active conversion to laparotomy is also a selection when local adhesion can not separated safely.

关 键 词：腹腔镜胆囊切除术 顺行切除 逆行切除 顺逆结合 胆囊大部切除 

分 类 号：R657.4[医药卫生—外科学]