腹腔镜下复杂胆囊切除术119例临床分析  

Clinical Analysis on Complex Laparoscopic Cholecystectomy:119 Cases Report

作　　者：周后平 宋新 姚本能 周旅 

机构地区：[1]湘西自治州人民医院(吉首大学第一附属医院)肝胆外科,湖南吉首416000

出　　处：《中国现代手术学杂志》2017年第5期337-339,共3页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨腹腔镜胆囊切除术在复杂情况下的处理。方法回顾性分析2013年7月~2016年7月119例腹腔镜下行复杂胆囊切除术患者的临床资料。其中,胆囊结石合并急性化脓性胆囊炎55例,坏疽性胆囊炎20例,胆囊穿孔12例,萎缩性胆囊炎27例,残余胆囊切除5例。35例有腹部手术史。术中采用"刮吸"、"推扒"的操作方法分别显露胆囊前、后三角;出血较多时使用干纱布填塞出血部位;遇到胆囊张力较高影响手术视野时先行胆囊减压。结果本组119例均顺利完成腹腔镜胆囊切除术,平均手术时间75(45~220)min。术后无明显出血,无胆漏发生,术后伤口疼痛予以对症处理后症状缓解。留置引流管的92例患者于术后1~3 d复查腹部B超后拔除引流管,术后第3~7 d出院,术后平均住院日4.2 d。术后随访1~3个月均无相关并发症发生。结论腹腔镜胆囊切除术可适用于复杂患者,合理熟练使用吸引器及干纱布可使手术过程简化。Objective To explore the management of laparoscopic cholecystectomy（LC） in complicated cases. Methods The clinical data of 119 patients performed difficult LC were retrospectively analyzed,including 55 of cholecystolithiasis combined with acute suppurative cholecystitis,20 of gangrenous cholecystitis,12 of perforation of gallbladder,27 of atrophic cholecystitis and 5 of residual gallbladder removal. 35 cases had abdominal surgery history. The aspirator and dry gauze were used during the operation. Results All 119 cases were accomplished the LC successfully without conversion to open surgery. The operative time was 45 to 220 minutes with an average of 75 minutes. No associated postoperative complications such as hemorrhage and bladder leakage occurred during 1 to 3 months follow-up. The drainage tube was pulled out 1 to 3 days after ultrasonic exam. Conclusions LC is safe and effective for complex cholecystectomy patients. The surgical process can be simplified by skilled application of aspirator and dry gauze.

关 键 词：胆囊切除术 腹腔镜 吸引器 外科纱布 

分 类 号：R657.4[医药卫生—外科学]