应用腹腔镜胆囊次全切除术治疗复杂性胆囊炎的临床研究  

Usefulness of Laparoscopic Subtotal Cholecystectomy for Complicated Cholecystitis

作　　者：李怡[1] 刘现立[1] 

机构地区：[1]河南科技大学第一附属医院普外科腹腔镜治疗中心,河南洛阳471003

出　　处：《中国伤残医学》2015年第11期12-14,共3页Chinese Journal of Trauma and Disability Medicine

摘　　要：目的：探讨应用腹腔镜胆囊次全切术（LSC）治疗复杂性胆囊炎的临床应用价值。方法：2011年1月-2013年12月完成腹腔镜治疗复杂性胆囊炎52例列为研究组，其中17例实施LSC，3例中转开腹，32例实施腹腔镜胆囊切除术（LC）；将2008年1月-2010年12月未开展LSC手术的复杂性胆囊炎76例列为对照组，其中14例中转开腹，62例完成LC。比较2组病例的临床特征、中转开腹率、开腹原因以及术后解剖变异和病理特征。结果：（1）研究组中转开腹率5．8％，低于对照组（18．4％），差异有统计学意义（P〈0．05）；中转开腹率的原因均为术中胆道损伤或胆囊动脉出血，二者发生率差异无统计学意义（P〉0．05）。（2）胆囊与胆总管致密粘连和Calot’s三角纤维化是LSC和开腹手术的主要病理改变，二者差异无统计学意义（P〉0．05）。结论：LSC作为LC手术的补充，能够有效降低复杂性胆囊炎术中并发症的发生，有效降低中转开腹的发生，进而提高复杂性胆囊炎的腹腔镜手术的治愈率。Objective： To evaluate the clinical value of complicated cholecystitis using laparoscopic subtotal cholecystectomy （LSC）. Methods： Fifty -two patients who underwent laparoscopy from November 2011 to December 2015 as the study group, 17 cases were per- formed with LSC, 3 cases with conversion to open surgery, 32 cases with LC. Seventy -six patients between January 2008 and October 2011 as the control group, 14 cases were converted to open operation, 62 with LC. Clinical features, the rate and reasons of conversion to open surgery, anatomical variations, and pathological features were compared. R^ults： （ 1 ） The rate of open operation of the study group was 5.8% lower than that of the control group （ 18.4% ） ; the difference was statistically significant （ P 〈 0.05）. Bile duct injury or bleeding of cystic artery are the main reasons for them, the difference of the constituent ratio is not statistically significant （P 〉 0.05）.（2） The gallbladder and common bile duct dense adhesions and Calotg triangle fibrosis are the main pathologic changes of LSC and open operation, no statistically significant difference between t^e two groups （ P 〉 0.05 ）. Conclusions： As an additional means, KSC can ef- fectively reduce the intraoperative complications and the incidence of conversion to laparotomy, and improve the recovery rate of complicated chplecystitis with laparoscopic operation.

关 键 词：腹腔镜胆囊次全切术 腹腔镜胆囊切除术 复杂性胆囊炎 中转开腹 

分 类 号：R657.4[医药卫生—外科学]