急性胆囊炎胆囊颈管结石嵌顿的腹腔镜胆囊切除术  

Experiences of Emergency Laparoscopic Cholecystectomy for Acute Cholecystitis Patients with Gallstone Incarcerated in Cervical Cystic Ducts

作　　者：朱建平 牟东成 薛晨辉 余国华 杨广伟 李永猛 马双飞 张奇峰 赵勇 赵磊 王海涛 孙伟光 谭建平 ZHU Jian-ping;MOU Dong-cheng;XUE Chen-hui;YU Guo- hua;YANG Guang-wei;LI Yong-meng;MA Shuang-fei;ZHANG Qi-feng;ZHAO Yong;ZHAO Lei;FANG Hai-tao;SUN Wei-guang;TAN Jian-ping(Department of Hepatobiliary Surgery, Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing 100018, China;Department of Surgery, Tangx- Jan Kangding Hospital, Baoding 072350, Hebei , China;Department of General Surgery, Yuping Dong Auton- omous County People＇ s Hospital, Yuping 554000, Guizhou, China)

机构地区：[1]北京市第一中西医结合医院肝胆外科,北京100018 [2]河北省保定市唐县康定医院外科,保定072350 [3]贵州省玉屏侗族自治县人民医院普外科,玉屏554000

出　　处：《中国现代手术学杂志》2018年第1期10-13,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的总结急诊腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗急性胆囊炎胆囊颈管结石嵌顿的心得体会。方法回顾性分析急性胆囊炎胆囊颈管结石嵌顿51例的临床资料,手术采用四孔法和吸引器推吸钝性分离以及Hartmann袋或胆囊管切开取石法行腹腔镜胆囊切除术。结果 49例(96.1%)顺利完成LC,2例(3.9%)患者术中无法辨清胆囊三角的结构关系而及时中转开腹,无胆管损伤发生,切口感染3例(5.9%),51例均痊愈,术后平均4.5(2~10)d出院。结论急诊腹腔镜胆囊切除治疗急性胆囊炎胆囊颈管结石嵌顿是安全可行的,在胆囊三角解剖困难时,采用Hartmann袋或胆囊管切开取石后再行腹腔镜胆囊切除是预防胆管损伤的好方法。Objective To study the experiences of emergency laparoscopic cholecystectomy for acute cholecystitis patients with gallstones incarcerated in cervical cystic ducts. Methods Clinical data of 51 cases of acute cholecystitis with gallstone incarcerated in cervical cystic ducts treated by emergency laparoscopic cholecystectomy were retrospectively analyzed. The cases received the surgical approaches of the four-trocar incision and Hartmann＇ s pouch lithotomy with blunt dissection. Rusults 49 cases（96. 1%） finished the laparoscopic cholecystectomy successfully,and 2 cases（3. 9%） converted to open cholecystectomy without bile duct injury. 3 cases（5. 9%） had incision infection. All the cases recovered,with the postoperative hospital stay of 4. 5（2 ~ 10） days. Conclusions It is safe and feasible of emergency laparoscopic cholecystectomy for acute cholecystitis patients with gallstones incarcerated in cervical cystic ducts. The technique of Hartmann＇ s pouch lithotomy is helpful.

关 键 词：胆囊炎 急性 胆囊切除术 腹腔镜检查 胆管损伤 

分 类 号：R657.4[医药卫生—外科学]