腹腔镜治疗亚急性胆囊炎的安全性分析(附1442例报告)  

Safety evaluation of laparoscopic surgery for 1 442 patients with subacute cholecystitis

作　　者：尚培中[1] 苗建军[1] 李晓武[1] 刘冰 王金[1] 张伟[1] 吕瑞昌 张金江[1] 翟佳琪[1] 柳勇[1] 张洁 SHANG Pei-zhong;MIAO Jian-jun;LI Xiao-wu(Department of General Surgery,the 251st Hospital of PLA,Zhangjiakou 075000,China)

机构地区：[1]中国人民解放军第二五一医院,河北张家口075000

出　　处：《腹腔镜外科杂志》2019年第4期293-296,共4页Journal of Laparoscopic Surgery

基　　金：河北省科学技术研究与发展计划项目(11276103D-21)

摘　　要：目的:探讨腹腔镜手术治疗亚急性胆囊炎的技术要点及安全性。方法:2007年3月至2018年2月为1 442例亚急性胆囊炎患者行腹腔镜手术,根据病理改变酌情进行个体化治疗,包括传统经典胆囊切除术、胆囊大部切除、胆囊部分切除、胆囊纵向直接剖开取石、胆囊横向分割切除等术式。结果:815例行胆囊切除术,627例行胆囊不完全切除术,无一例中转开腹及胆管损伤。122例合并胆总管结石,35例同期行腹腔镜胆总管探查取石,64例术后再次手术行腹腔镜胆总管探查取石,23例行内镜十二指肠乳头括约肌切开术取石。结论:淡化胆囊切除的多寡,取净结石,妥善处理胆囊管或胆囊壶腹,废弃胆囊功能,亚急性胆囊炎患者可安全施行腹腔镜手术。Objective:To explore the technical essentials and safety of laparoscopic surgery for subacute cholecystitis.Methods:From Mar.2007 to Feb.2018,1 442 patients of subacute cholecystitis were treated by laparoscopy.Traditional classical laparoscopic total cholecystectomy was performed on the non-difficult gallbladder.Laparoscopic bail-out procedures including subtotal cholecystectomy,partial cholecystectomy,longitudinal splitting and transecting approach were chosen for difficult gallbladder according to the individual conditions.Patients complicated with choledocholithiasis underwent simultaneous laparoscopic common bile duct exploration or postoperative retreatment.Results:Laparoscopic total cholecystectomy was performed in 815 cases.Bail-out procedures were performed in 627 cases.All patients successfully underwent laparoscopic operation without conversion or bile duct injury.Among them,122 patients suffered from choledocholithiasis,35 patients were successfully treated by simultaneous laparoscopic common bile duct exploration,late laparoscopic common bile duct exploration was performed in 64 cases,endoscopic sphincterotomy in 23 cases.Conclusions:It is safe to implement the laparoscopic operation for subacute cholecystitis on the premise of following condition:dilution of the consciousness of complete cholecystectomy,complete removal of calculi,proper management of the cystic duct or gallbladder ampulla and disabled gallbladder function.

关 键 词：亚急性胆囊炎 胆囊切除术 腹腔镜 安全 

分 类 号：R657.4[医药卫生—外科学]