上腹部手术史患者行腹腔镜胆囊切除术的临床体会  

Laparoscopic cholecystectomy for patients with surgical history of upper abdomen

作　　者：刘兴国[1] 冯德元[1] 张东[1] 吴辉[1] 张雷华[1] 刘江伟[1] 郑文建[1] 候元凯[1] 

机构地区：[1]兰州军区乌鲁木齐总医院,新疆乌鲁木齐830002

出　　处：《腹腔镜外科杂志》2011年第5期377-379,共3页Journal of Laparoscopic Surgery

摘　　要：目的：探讨有上腹部手术史患者行腹腔镜胆囊切除术（laparoscop ic cholecystectomy,LC）的可行性及要点。方法：回顾分析2004年10月至2010年12月为128例有上腹部手术史的患者施行LC的临床资料。结果：115例成功完成LC,13例中转开腹,成功率89.84%。LC组手术时间35~240m in,平均（67.7±19.4）m in;中转组73~225m in,平均（89.3±16.8）m in。LC组术中出血量5~100m l,平均（23.7±10.6）m l;中转组50~1 000m l,平均（200.6±45.9）m。lLC组术后住院3~5d,平均（3.6±0.8）d;中转组8~23d,平均（11.3±3.4）d。LC组术后无并发症发生;中转开腹组1例切口脂肪液化,1例切口感染,无其他并发症发生。所有病例均治愈出院。结论：有上腹部手术史不应成为LC的禁忌,但具体术式应根据术前判断和患者的具体情况决定。Objective：To study the feasibility and characteristics of laparoscopic cholecystectomy（LC） for patients with surgical history of upper abdomen.Methods：The clinical data of 128 patients from Oct.2004 to Dec.2010 with surgical history of upper abdomen performed LC was retrospectively analyzed.Results：LC was successfully performed in 115 cases and 13 cases were converted to open operation.The success rate of LC operation was 89.84%（115/128）.The operation time was 35-240min in LC group,mean（67.7±19.4）min;73-225min in laparotomy group,mean（89.3±16.8）min.The blood loss was 5-100ml in LC group,mean（23.7±10.6）ml;5-1 000ml in laparotomy group,mean（200.6±45.9）ml.The postoperative hospital stay was 3-5d in LC group,mean（3.6±0.8）d;8-23d in laparotomy group,mean（11.3±3.4）d.There were no complications in LC group,1 case of incision fat liquefaction and 1 case of incision infection acurred in conversion group.No other complications occurred,all patients were cured and discharged.Conclusions：LC is feasible on patients with surgical history of upper abdomen,but the selection of Trocar position,completion of pneumoperitoneum and dissection of adhesion should be individualized.

关 键 词：胆囊切除术 腹腔镜 上腹部手术史 再手术 

分 类 号：R657.4[医药卫生—外科学]