腹腔镜胆囊切除术治疗86例急性结石性胆囊炎患者的临床效果  

Experience in laparoscopic cholecystectomy in treatment of acute calculous cholecystitis: a clinical analysis of 86 cases

作　　者：赵国平[1] 胡建平[1] 王吉荣[1] 张明[1] ZHAO Guoping, HU Jianping, WANG Jirong, et al.(Department of General Surgery, Nanjing Jiangning Hospital Affiliated to Nanjing Medi- cal University, Nanfing 211100, Chin)

机构地区：[1]南京医科大学附属南京江宁医院普外科,南京211100

出　　处：《临床肝胆病杂志》2018年第3期517-520,共4页Journal of Clinical Hepatology

摘　　要：目的总结分析腹腔镜胆囊切除术(LC)治疗急性结石性胆囊炎的临床应用效果。方法回顾性总结2016年5月-2017年5月南京医科大学附属南京江宁医院普外科应用LC治疗急性结石性胆囊炎86例患者的临床资料。结果手术时间为发病后1周内,手术持续时间60~130 min,平均(75.5±10.5)min,术中出血量40~200 ml,平均(70±11.2)ml;术后住院时间3~14d,平均(6±1.5)d。86例患者中急性单纯性胆囊炎40例、急性化脓性胆囊炎38例、急性坏疽性胆囊炎5例,3例慢性胆囊炎急性发作;有6例中转为开腹胆囊切除术,其余80例均成功完成LC,包含1例胆囊十二指肠内瘘加行十二指肠一期修补术。术中行胆道造影20例,1例发现合并有胆总管结石,遂行胆总管探查术、T管引流;另有2例经造影确定存在胆道损伤,均在术中予以修补,1例放置T管引流,1例行一期缝合。1例患者术后胆漏,经保守治疗后治愈,余患者均无胆漏、出血等并发症。结论对于急性结石性胆囊炎,遵守严格的适应证和掌握充分的腹腔镜技术,创伤较小且安全有效。Objective To investigate the clinical effect of laparoscopic cholecystectomy（ LC） in the treatment of acute calculous cholecystitis. Methods A retrospective analysis was performed for the clinical data of 86 patients with acute calculous cholecystitis who underwent LC in Department of General Surgery in Nanjing Jiangning Hospital Affiliated to Nanjing Medical University from May 2016 to May 2017. Results The surgery was performed within 1 week after disease onset,with a time of operation of 60-130 minutes（ mean 75. 5 ± 10. 5 minutes）,an intraoperative blood loss of 40-200 ml（ mean 70 ± 11. 2 ml）,and a length of postoperative hospital stay of 3-14 days（ mean6 ± 1. 5 days）. Of all 86 patients,40 had simple acute cholecystitis,38 had acute pyogenic cholecystitis,5 had acute gangrenous cholecystitis,and 3 had an acute exacerbation of chronic cholecystitis; 6 patients were converted to open surgery,and 80 underwent a successful surgery,among whom one underwent primary duodenal repair due to cholecystoduodenal fistula. Intraoperative cholangiography was performed for 20 patients,among whom one was found to have common bile duct stones,and then common bile duct exploration and T-tube drainage were performed; two patients were found to have bile duct injury,which was repaired during surgery,and T-tube drainage was performed for one patient and primary suture was performed for the other patient. One patient experienced bile leakage after surgery and was cured after conservative treatment; all the other patients had no complications such as bile leakage and bleeding. Conclusion For acute calculous cholecystitis,indications should be strictly followed and laparoscopy should be adequately mastered. LC is safe and effective with little trauma.

关 键 词：胆囊炎 急性 胆囊结石病 胆囊切除术 腹腔镜 

分 类 号：R657.4[医药卫生—外科学]