腹腔镜胆囊次全切除术在困难性胆囊切除中的应用  被引量:20

Application of laparoscopic subtotal cholecystectomy for complicated laparoscopic cholecystectomy

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作  者:高君[1] 孙文兵[1] 张延峰[1] 柯山[1] 丁雪梅[1] 

机构地区:[1]首都医科大学附属北京朝阳医院西区肝胆胰脾外科,100043

出  处:《中国综合临床》2010年第4期423-425,共3页Clinical Medicine of China

摘  要:目的 探讨腹腔镜胆囊次全切除术(LSC)在困难性胆囊切除中的应用效果.方法 2006年6月至2009年2月,我院对40例解剖困难的胆囊结石患者行LSC.根据局部病理情况,采取3种LSC术式.其保留部分胆囊床(LSC Ⅰ式)9例,保留部分胆囊壶腹(LSC Ⅱ式)18例,保留部分胆囊床和壶腹(LSC Ⅲ式)13例.并在同期行腹腔镜胆囊切除术(LC)的384例病例中,按照性别相同,年龄、炎症类型、手术难度相近的原则,选择40例与LSC组一一配对,作为对照组.对比观察临床疗效.结果 LSC组和LC组均顺利在腹腔镜下完成手术,无中转开腹和胆道损伤发生.术中出血量LSC组[(73±26)ml]多于LC组[(41±12)ml],差异有统计学意义(t=4.183,P〈0.05).手术时间LSC组[(77±15)min]与LC组[(81±14)min]比较,差异无统计学意义(t=1.538,P〉0.05).住院天数LSC组[(6±6)d]与LC组[(7±5)d]比较,差异无统计学意义(t=0.616,P〉0.05).LSC组的术者主要为腔镜经验5~10年(5~10年与10年以上的比例为32/8).LC组的术者主要为腔镜经验10年以上(5~10年与10年以上的比例为7/33),两者比较,差异有统计学意义(χ^2=34.690,P〈0.05).LSC组中2例(5.0%),LC组中3例(7.5%)术后出现胆漏(χ^2=0.231.P〉0.05),均经保守治疗治愈.所有患者均病愈出院,术后随访无胆道狭窄、梗阻和残留小胆囊等并发症.结论 胆囊解剖困难时,LSC是一个安全、有效的选择,可避免传统的中转开腹手术.Objective To evaluate the application of laparoscopic subtotal cholecystectomy (LSC) for complicated laparoscopic cholecystectomy(LC).Methods From June,2006 to February,2009,40 patients with complicated cholecystitis underwent LSC in our hospital were admitted.9 were operated by leaving the posterior wall intact with the liver (LSC Ⅰ),18 were operated by leaving the cystic duct(LSC Ⅱ),13 with a combination of LSC Ⅰ and LSC Ⅲ(LSC Ⅲ).According to rules of same sex.similar inflammation and complicated degree,40 cases were selaparoscopy successfully,none was converted to laparotomy and damaged the bile duct.Intraoperative bleeding in LSC group(73±26)ml increased significantly than those in LC group(41±12)ml(t=4.183,P〈0.05).The operative time((77±15)min vs.(81±14)min) and postoperative hospital stays((6±6)d vs.(7±5)d)were not different between the two groups(t=1.538,0.616,P〉0.05).In LSC group,operators were mostly the laparoscopie surgeon with five to ten years experience(32/8),whereas in LC group,mostly were with above ten years experience(7/33)(χ^2=34.690,P〈0.05).3 cases in LC group(7.5%) and 2 cases in LSC group(5%) had bile leaks and cured with conservative treatment(χ^2=0.231,P〉0.05).All patients were cured,and no complications occurred.Conclusions LSC is a safe and effective procedure in LC with complicated cholecystitis,without incurring of laparotomy.

关 键 词:胆囊结石 腹腔镜胆囊次全切除术 腹腔镜胆囊切除术 

分 类 号:R657.4[医药卫生—外科学]

 

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