腹腔镜胆囊切除术中胆囊管的处理体会  

Experience of cystic duct treated in laparoscopic cholecystectomy

作　　者：赵海俊[1] 杨英起[1] 赵臣[1] 宋强[1] 

机构地区：[1]包头医学院第三附属医院(包头市北方医院),内蒙古包头014030

出　　处：《腹腔镜外科杂志》2015年第9期673-674,共2页Journal of Laparoscopic Surgery

摘　　要：目的：探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）中胆囊管残端处理的经验。方法：回顾分析2010年3月至2015年3月为1 568例患者行LC的临床资料,其中术后胆囊管残端形成结石15例,9例为急性胆囊炎发作期手术,6例为胆囊管解剖变异。结果：4例在腹腔镜下完成手术,11例中转开腹。患者术后上腹部隐痛不适、肩胛间区疼痛、食欲不振等症状均缓解,术后无胆漏、胆道狭窄等并发症发生,术后随访3个月~4年,彩超及MRCP提示均未见胆囊管结石或胆总管结石。结论：LC术中处理胆囊管时胆囊管残端应尽量短,最好做到与胆总管切线位,以预防术中胆囊管残端残余结石及术后残端再发结石。Objective： To explore the experience of treatment of remnant cystic duct in laparoscopic cholecystectomy（ LC）.Methods： The clinical data of 1 568 patients who underwent LC from Mar. 2010 to Mar. 2015 were retrospectively analyzed. Of all the1 568 patients,cystic duct remnant calculi were diagnosed after LC in 15 patients. Of all the 15 patients,9 cases were acute cholecystitis,6 cases were anatomic variation of gallbladder duct. Results： The cystic duct remnant calculi of 4 patients were treated successfully by laparoscopy,and 11 patients were converted to open operation. Upper abdominal pain and discomfort,interscapular pain,loss of appetite and other symptoms relieved after surgery,no complications such as biliary leakage or stricture occurred. During the follow-up of 3months to 4 years,color Doppler ultrasound and MRCP showed no cystic duct stones or common bile duct stones. Conclusions： The treatment of cystic duct stump is as short as possible in LC,the best is tangent with the common bile duct,it can prevent the intraoperative residual calculi and postoperative recurrent calculi of the remnant cystic duct.

关 键 词：胆囊切除术 腹腔镜 胆囊管残端 残余结石 

分 类 号：R657.4[医药卫生—外科学]