急性胆囊炎“延期”腹腔镜胆囊切除的手术技巧及并发症预防  

Technical difficulties and avoidance of complications in delayed laparoscopic cholecystectomy for acute cholecystitis

作　　者：朱斌[1] 张展志[1] 张能维[1] 宫轲[1] 路夷平[1] 王岩[1] 阿民布和[1] 李凯[1] v 

机构地区：[1]首都医科大学附属北京世纪坛医院普外科,100038

出　　处：《中华肝胆外科杂志》2011年第10期820-822,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨急性胆囊炎延期腹腔镜胆囊切除术（LC）的手术技巧及并发症预防。方法将2004年2月至2008年8月收治的133例急性胆囊炎行LC患者，按急性胆囊炎发作后手术治疗的时间分为两组：急性发作72h内手术的为早期组（34例）和急性发作72h后手术的延期组（99例）。手术技巧是沿胆囊壶腹分离胆囊管，尽量充分“掏空”、显露Calot三角，顺行切除胆囊；如Calot三角粘连紧密，解剖关系不清，可逆性切除胆囊或自壶腹部行胆囊大部切除术。延期组手术难度增大主要集中在Calot三角的处理上。结果133例全部完成LC手术，无中转开腹，无胆道损伤及胆漏等并发症，无术后30d再入院。顺行切除术127例，逆行切除术2例，胆囊大部切除术4例。延期组较早期组LC手术时间延长[（44．1±5．32）min比（66．4±3．05）min，P〈0．01]；两组切口感染率比较差异无统计学意义（2．94％比2．02％，P〉0．05）。结论延期LC较早期LC难度增大，但同样安全可行；把握好LC的手术技巧和熟练的技术是预防并发症的关键所在。Objective To investigate the technical difficulties and the avoidance of complications in delayed laparoscopic cholecystectomy （LC） for acute cholecystitis （AC）. Methods The results of LC carried out on 133 consecutive patients with AC between February 2004 and August 2008 were ret-rospectively studied. The outcomes were compared between patients who received LC for AC within 72 hours （the early group） and those after 72 hours （the delayed group）. There were 34 patients in the early group and 99 in the delayed group. During LC, Calot＇s triangle was carefully dissected, and the relationship of the cystic duct to the CBD and common hepatic duct was clearly identified. Retro- grade cholecystectomy in 2 patients was used when the Calofs triangle was poorly identified. Laparoscopic subtotal cholecystectomy was carried out in 4 patients whose inflammation or fibrosis precluded dissection of the Calot＇s triangle. Results There was no conversion to open cholecystectomy, biliary tract injury, biliary leak, or any other intraoperative or postoperative complications. There was no 30- day readmission in the 2 groups. Patients who received delayed LC had a significantly longer operation time [（44.1±5.32） vs （66.4±3.05）min, P〈0.01]. There was no significant difference in wound infection rates in the 2 groups （1/34 2.94% vs 2/99 2.02%,P〉0.05）. Conclusions Delayed LC was as feasible and safe as early LC in the treatment of AC. Delayed LC was technically more demanding than early LC.

关 键 词：急性胆囊炎 腹腔镜胆囊切除术 并发症预防 手术技巧 

分 类 号：R657.4[医药卫生—外科学]