钝性冷分离结合Calot后三角解剖入路防止腹腔镜胆囊切除术中的胆管损伤  

Blunt cold dissection combined with posterior Calot's triangle approach for the prevention of bile duct injury in laparoscopic cholecystectomy

作　　者：郝建宏[1] 许明辉[1] 胡娟英[1] 

机构地区：[1]海宁市人民医院,浙江海宁314400

出　　处：《腹腔镜外科杂志》2014年第2期135-137,共3页Journal of Laparoscopic Surgery

摘　　要：目的：探讨钝性冷分离结合Calot后三角解剖入路在腹腔镜胆囊切除术（1aparoscopiccholecystectomy，LC）中防止胆管损伤的临床效果及应用价值。方法：Lc术中切断胆囊管前常规先钝性冷分离处理Calot三角，明确胆囊壶腹、胆囊管、胆囊动脉后再切断胆囊管。结果：全组959例（98．5％）顺利完成手术，无一例胆道损伤；15例（1．5％）中转开腹，其中8例Calot三角致密粘连，3例因术中冰冻病理报告提示胆囊癌中转开腹行胆囊癌根治术，2例为Mirizzi综合征，2例为胆囊十二指肠内瘘。手术时间20～105min，平均（50．074-16．2）min；术中出血量5～120ml，平均（55．11±28．37）ml；术后随访3～24个月，无发热、腹痛、黄疸、胆囊窝血肿、积液及胆道狭窄等并发症发生。结论：LC术中采用钝性冷分离结合Calot后三角解剖入路，可有效防止术中胆管损伤，进一步提高Lc的安全性。Objective：To investigate the clinical outcomes and application value of blunt cold dissection combined with posteri- or Calot triangle approach for the prevention of bile duct injury in laparoscopic cholecystectomy （LC）. Methods：LC was performed on 974 patients, the cholecystic ampulla, the cystic duct and the cystic artery were exposed by routinely blunt cold dissection before tran- secting the cystic duct. Results：LC was successfully completed in 959 cases （98.5%） and no bile duct injury occurred. 15 cases （ 1.5% ） were converted to open procedure,8 cases for Calot triangle compact adhesion,3 cases for gallbladder cancer,2 cases for Mi- rizzi syndrome,2 cases for internal fistula of gallbladder to duodenum. The operation time ranged from 20 to 105 min with a mean of （50.07 ＋ 16.2） min,and the intraoperative blood loss was （55.11 ＋28.37） ml on average （ranged,5-120 ml）. The patients were fol- lowed up for 3 to 24 months, during which no fever, abdominal pain or jaundice was found, imaging examination revealed no hematoma, hydrops of the gallbladder bed nor biliary stricture. Conclusions ： Using blunt cold dissection combined with posterior Calot triangle ap- proach in LC can prevent intraoperative bile duct injury and improve the security of LC.

关 键 词：胆囊切除术 腹腔镜 钝性冷分离 CALOT三角 胆管损伤 

分 类 号：R657.4[医药卫生—外科学]