腹腔镜胆囊切除术中胆囊管结石嵌顿的处理体会  

Therapy for calculus incarcerated in the duct of gallbladder during laparoscope choledcloscopy

作　　者：康明[1] 汪朝晖[1] 

机构地区：[1]安庆市第一人民医院普普外科,安庆246004

出　　处：《肝胆外科杂志》2015年第2期107-109,共3页Journal of Hepatobiliary Surgery

摘　　要：目的探讨胆囊管结石嵌顿的腹腔镜胆囊切除术（LC）的手术时机和安全性。方法回顾性分析2011年5月至2013年12月我院普外科诊治的48例胆囊管结石嵌顿患者行LC术的临床资料。术中充分游离胆囊三角,骨骼化胆囊动脉、胆囊管、明确显露出胆囊管与胆总管汇合部,依据胆囊管内嵌顿结石大小,及胆囊管同肝总管汇合部的距离给予不同处理方式。结果 44例患者顺利行LC术,4例中转开腹,40例取石成功,除2例出现胆汁漏外均未发生胆管损伤,出血,结石残留等并发症,术后住院时间4~12d.术后随访3个月到35个月均未发生胆道狭窄等并发症。结论灵活运用LC术的处理技巧,胆囊管结石嵌顿时候行LC是安全可行的,但必要时仍需中转开腹。Objective To inverstigated the time and safety for calculus incarcerated in the duct of gallbladder during laparo- scopic cholecystectomy. Methods The retrospective analysis was made on the clinical data of 48 patients, who suffered by incarcera- ted gallstones in the duct of gallbladder from May 2011 to Dec 2013 in our hospital. The Calot＇ s triangle was fully separated. The crys- tic artery and duct were skeletonized to expose the join of cystic duct and common bile duct and to remove the stone with different meth- ods according to the size of stone and the distance between the stone and join of cystic duct and CBD. Results The LC was sucessfully completed in 40 cases（ 83.3% ） ,4 cases were converted to open surgery. There were no complication except to in 2 case with bile leak- age. They were all discharged from 4 - 12 days. No complication was found during a 3 - 35 months follow-up. Conclusion It is safe and reasonable to select the correct operation chance and skills of operation during LC for calculus incarcerated in the duct of gallblad- der. But sometime it is suffered to convert to open surgery when necessary.

关 键 词：结石 结石嵌顿 腹腔镜胆囊切除术 

分 类 号：R657.4[医药卫生—外科学]