困难腹腔镜胆囊切除术100例分析  

An analysis of difficult laparoscopic cholecystectomy in one hundred cases

作　　者：张红卫[1] 陈亚进[1] 张磊[1] 

机构地区：[1]中山大学附属第二医院(孙逸仙纪念医院)肝胆外科,广州510120

出　　处：《中华腔镜外科杂志（电子版）》2010年第3期37-39,共3页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的探讨腹腔镜下完成困难胆囊切除术的可行性。方法腹腔镜下进行困难胆囊切除术100例(男53例,女47例)。其中急性化脓性胆囊炎52例(52%),上腹部手术史导致胆囊三角区严重粘连者18例(18%),萎缩性胆囊炎合并充满型胆囊结石17例(17%),胆囊结石合并门脉高压症7例(7%),Mirizzi综合征6例(6%)。结果 95例在腹腔镜下成功完成胆囊切除术,另外5例中转开腹手术,中转率为5%。中转原因包括:腹腔镜下无法控制的出血2例,难以辨认肝外胆管的位置3例。平均手术时间(82.1±18.5)min。所有患者均痊愈出院,平均住院时间(7.2±2.3)d。手术后并发症有:胆瘘2例,切口感染2例,肺部感染1例。结论在技术成熟的前提下,腹腔镜下完成困难的胆囊切除术是可行和相对安全的。Objective To investigate the feasibility of laparoscopic cholecystectomy in difficult cases. Methods Laparoscopic cholecystectomy was carried out in 100 patients （men 53, women 47） with complicated choMithiasis. Among them, 52 patients （ 52 % ） suffered from acute suppurative chotecystitis and 18 patients （ 18 % ） had dense adhesion of Calot＇s triangle caused by past upper abdominal operation. Seventeen patients （ 17 % ） suffered from chronic calculic atrophy cholecystitis with severe fibrosis, 7 patients （ 7 % ） from chronic calculic cholecystitis with cirrhotic portal hypertension, and 6 patients （ 6 % ） from Mirizzi syndrome. Results Laparoscopic cholecystectomy succeeded in 95 cases, while 5 patients were converted to open surgery. The conversion rate was 5 percent. The reasons of conversion included： uncontrollable bleeding under laparoscopy （ 2 cases ）, and unable to distinguish the location of the extrahepatic bile duct （ 3 cases ）. The median operation time was （ 82.1 ± 18.5 ） minutes. All patients were fully recovered and the mean hospital stay was （ 7.2± 2.3 ） days. The postoperative complications included： bile leak （ 2 patients ）, epigastric port infection and respiratory system infection. Conclusions Laparoscopic cholecystectomy for patients with complicated cholecystitis is feasible and relatively safe when the operator is skillful.

关 键 词：腹腔镜 困难胆囊切除 

分 类 号：R657.4[医药卫生—外科学]