三孔法腹腔镜胆囊切除术治疗胆囊结石嵌顿的临床分析  

The Clinical Analysis on Three-port Laparoscopic Cholecystectomy for Cholecystitis with Gallbladder Calculi Incarceration

作　　者：陈思瑞[1] 彭永海[1] 胡朝辉[1] 罗华[1] 

机构地区：[1]绵阳市中心医院肝胆外科,四川绵阳621000

出　　处：《华西医学》2016年第10期1678-1681,共4页West China Medical Journal

摘　　要：目的探讨三孔法腹腔镜胆囊切除术治疗胆囊结石嵌顿的可行性及特点。方法总结分析2010年7月-2014年12月收治的160例胆囊结石嵌顿行三孔法腹腔镜胆囊切除术的临床资料,104例结石嵌顿于胆囊颈部,20例结石嵌顿于胆囊管,36例结石嵌顿于胆囊壶腹部。择期手术120例,急诊手术40例。结果 160例患者中,154例（96.25%）成功完成三孔法LC,中转开腹手术6例,其中择期手术组2例（1.67%）,急诊手术组4例（10.00%）。择期手术组中转开腹手术的2例分别为Mirizzi综合征和胆囊癌;急诊手术组中转开腹手术的4例均为发病时间1周左右,胆囊结石嵌顿致三角区结构致密,胆囊壁水肿增厚达1.0 cm,腹腔镜下分离困难遂中转开腹手术。70例术中均有不同程度的胆囊增大、水肿,60例伴有不同程度的胆囊萎缩,30例胆囊大小基本正常。所有患者的胆囊均与大网膜和（或）结肠有不同程度的粘连。胆汁呈墨绿色黏稠胆汁80例,脓性胆汁10例,白色胆汁40例,胆囊空虚无胆汁30例。术后随访6-36个月,1例患者出院3个月后因反复出现剑突下疼痛不适于门诊复查发现继发胆总管结石1例,行内镜逆行胰胆管造影术取石后治愈出院。结论在术者具备熟练的操作技巧、能合理选择中转开腹时机的前提下,无论急诊还是择期手术,采用三孔法腹腔镜胆囊切除术治疗胆囊结石嵌顿均安全、可行。Objective To explore the feasibility and characteristics of three-port laparoscopic cholecystectomy（LC） in the treatment of cholecystitis with gallbladder calculi incarceration.Methods The clinical data of 160 patients with gallbladder calculi incarceration treated by three-port LC between July 2010 and December 2014 were analyzed retrospectively.Among the patients,there were 104 cases of calculi incarcerated in the gallbladder neck area,20 cases in the cystic gall duct,and 36 cases in the gallbladder ampullar region.Elective operations were carried out for 120 patients and 40 underwent emergency operation.Results Three-port LC was successfully completed in 154 patients（96.25%）,and the other 6 patients were converted to open surgery among whom 2 underwent elective operation（1.67%） and4 underwent emergency operation（10.00%）.Two converted patients in the elective operation group had Mirizzi syndrome and gallbladder carcinoma respectively;all the 4 converted patients in the emergency operation group had a disease course of about one week with compacted triangle structure and gallbladder edema thickening of 1.0 cm,causing difficult separation under laparoscope.Seventy patients had varying degrees of enlargement and edema of gallbladder,60 had varying degrees of gallbladder atrophy,and 30 had almost normal gallbladder.There were 80 cases of dark green thick bile,10 of purulent bile,40 of white bile,and 30 of empty gallbladder and no bile.No complications were found during the follow-up of 6 to 36 months,except that one patient was found to have secondary common bile duct stones three months after discharge,and the patient was cured by endoscopic retrograde cholangiopancreatography.Conclusions Elective or emergency three-port LC is safe and feasible for gallbladder calculi incarceration as long as the operator had skilled technique and made the right decision on opportunity of conversion.

关 键 词：三孔法腹腔镜胆囊切除术 胆囊结石嵌顿 临床分析 

分 类 号：R657.42[医药卫生—外科学]