急性胆囊炎行腹腔镜胆囊大部切除术中胆囊管残端开放式处理的临床观察  

Laparoscopic subtotal cholecystectomy without cystic duct stump ligation for severe acute cholecystitis

作　　者：秦建伟[1] 高静涛[2] 龚振斌[2] 徐琦[2] 王建国[2] 

机构地区：[1]兰州军区兰州总医院肝胆外科,甘肃兰州730050 [2]兰州军区解放军第一医院肝胆外科

出　　处：《西北国防医学杂志》2015年第11期721-723,共3页Medical Journal of National Defending Forces in Northwest China

摘　　要：目的：观察严重急性胆囊炎行腹腔镜胆囊大部切除术中胆囊管残端开放式处理的效果及可行性。方法：回顾性分析解放军第一医院肝胆外科2006-2012年急性胆囊炎行腹腔镜胆囊大部切除术中胆囊管残端无法常规行夹闭、结扎或缝扎而旷置处理的38例病例。其中26例胆囊管已自行闭锁,行单纯放置腹腔引流管;12例胆囊管未完全闭锁,行胶原蛋白封堵加腹腔引流。观察术后引流及恢复情况。结果：32例（84.2%）术后无胆漏;6例（15.8%）患者术后早期出现轻度胆漏,其中5例于术后10d内胆漏停止,另1例术后16d停止。B超检查肝下、腹腔无积液后拔除引流管。21例患者术后随访3-7年,情况良好。结论：急性胆囊炎行腹腔镜胆囊大部切除术中,困难情况下,对胆囊管残端已经闭锁或基本闭锁的患者采用开放式处理,是一种安全的选择。Objective：To analyze the effect and feasibility of laparoscopic subtotal cholecystectomy（LSC）without cystic duct stump ligation for severe acute cholecystitis（SAC）.Methods：Thirty-eight SAC patients undergoing LSC without cystic duct stump ligation were retrospectively analyzed.The cystic duct stump couldn＇t be closed with clip or suture in all patients because of severe inflammation.The infrahepatic drainage tube was placed for 26 patients with completed obstruction of cystic duct,and the cystic duct was closed with medical collagen protein for the other 12 patients with partial obstruction of cystic duct.Results：No bile leak was found in 32 patients,while early mild bile leak was observed postoperatively in6 patients.The bile leak stopped within 10 days after surgery in 5patients,and within 16 days in another patient.The drainage tube was removed after ultrasound examination.No postoperative complication was observed in 21 patients during a follow-up period of 3to 7years.Conclusion：The LSC without cystic duct stump ligation is safe and feasible for SAC patients with completed or partial obstruction of cystic duct.

关 键 词：胆囊大部切除术 严重急性胆囊炎 胆囊管残端 

分 类 号：R657.41[医药卫生—外科学]