腹腔镜治疗急性化脓性胆囊炎452例  

Laparoscopic Cholecystectomy for Acute Suppurative Cholecystitis:a Report of 452 Cases

作　　者：毕保洪[1] 李华[1] 李伟[1] 张朝永 

机构地区：[1]河北联合大学附属唐山市中医医院肝胆外科,唐山063000

出　　处：《中国微创外科杂志》2014年第10期917-919,926,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的：探讨腹腔镜胆囊切除术（ laparoscopic cholecystectomy， LC）治疗急性化脓性胆囊炎的处理方法及并发症的预防措施。方法2003年10月～2013年6月我院采用四孔法LC治疗急性化脓性胆囊炎452例，因胆囊三角水肿和（或）粘连严重而无法分离，采用逆行腹腔镜胆囊部分切除术（ laparoscopic partial cholecystectomy，LPC），胆囊管不能常规夹闭，采用缝扎或胆囊管开口处直接放置引流管引流，术后均常规放置腹腔引流管引流。结果3例因解剖困难中转开腹手术，382例成功完成LC，67例行LPC。 LC手术时间（55±20） min，术中出血量（80±10） ml；LPC手术时间（61±15） min，术中出血量（75±15） ml。术后胆漏21例，其中19例保守治疗成功，2例开腹治疗成功；切口感染致延期愈合18例。术后住院3～15 d，平均6．5 d。成功实施腹腔镜手术的449例，术后随访6～24个月（平均14个月），21例因其他疾病死亡，余428例无并发症发生。结论 LC治疗急性化脓性胆囊炎是一种安全可靠的方法，但及时中转开腹手术仍是手术医师最明智的选择。Objective To investigate the management methods and complication prevention of laparoscopic cholecystectomy （ LC） for acute suppurative cholecystitis. Methods From October 2003 to June 2013, we performed 4-port LC on 452 patients with acute suppurative cholecystitis.The patients were given laparoscopic partial cholecystectomy （ LPC） by retrograde dissection because of serious edema and （ or ） adhesion of gallbladder triangle.Because the cystic ducts could not be clipped by conventional methods, primary suture or drainage tube placement was performed near the opening of the cystic duct.An abdominal cavity drainage tube was placed in all the cases. Results Among the 452 patients, LC was performed successfully in 382 patients, conversions to open surgery because of exposure difficulties were required in 3 patients, and LPC was conducted in 67 patients.The operative time of LC was （55 ±20）min,and the blood loss was （80 ±10） ml;the operative time of LPC was （61 ±15） min,and the blood loss was （75 ± 15） ml.Postoperatively, bile leakage occurred in 21 patients, 19 of which were cured by conservative treatment and 2 of which were given a secondary open surgery.Wound infection leading to delayed healing was recorded in 18 patients.After operation, the length of hospital stay was 3-15 days （ mean, 6.5 days） .Among 449 patients with successful LC, post-operative follow-up for 6-24 months （ mean, 14 months） found no complications in 428 patients and death due to other diseases in 21 patients. Conclusion LC for acute suppurative cholecystitis is safe and dependable, but converting to open surgery in time is the most advisable choice for the operating doctor.

关 键 词：腹腔镜胆囊切除术 急性化脓性胆囊炎 

分 类 号：R657.4[医药卫生—外科学]