腹腔镜开窗式胆囊大部切除术的临床应用  

Clinical application of laparoscopic subtotal cholecystectomy with fenestration

作　　者：曾江东 张艺萍 莫健文[2] 司徒升[2] ZENG Jiang-Dong;ZHANG Yi-ping;MO Jian-wen(Department of Surgery,Shuikou Hospital of Kaiping Central Hospital,Jiangmen 529321,China;Central Hospital of Kaiping)

机构地区：[1]开平市中心医院水口分院,广东开平529321 [2]开平市中心医院

出　　处：《腹腔镜外科杂志》2019年第4期297-300,共4页Journal of Laparoscopic Surgery

摘　　要：目的:探讨腹腔镜开窗式胆囊大部切除术治疗急性胆囊炎的临床应用。方法:回顾分析2010年12月至2017年12月为23例急性胆囊炎行胆囊切除困难的患者行腹腔镜开窗式胆囊大部切除术的临床资料。结果:23例手术均顺利完成,无一例中转开腹,手术时间平均(62±11)min,术中出血量平均(85±25)mL,术后排气时间平均(23.5±2.6)h;术后6 h饮水,24 h进食;无腹腔出血、肠管损伤、肝外胆管损伤、胆汁性腹膜炎等并发症发生;术后5～7 d痊愈出院。随访4～48个月,术前临床症状消失,饮食正常。结论:急性期胆囊炎患者行腹腔镜开窗式胆囊大部切除术可避免强行解剖胆囊三角,减少胆管、血管损伤等并发症的发生,手术安全、可行,是治疗急性胆囊炎及复杂困难型胆囊的有效术式。Objective: To investigate the clinical application of laparoscopic subtotal cholecystectomy with fenestration in the treatment of acute cholecystitis. Methods: Clinical data of 23 patients of acute cholecystitis with difficult cholecystectomy who underwent laparoscopic subtotal cholecystectomy with fenestration were retrospectively analyzed from Dec.2010 to Dec.2017. Results: Twenty-three operations were successfully performed,no conversion to laparotomy,and no complications such as abdominal hemorrhage,intestinal injury,extrahepatic bile duct injury or biliary peritonitis occurred.The operative time was (62±11)min,intraoperative blood loss was (85±25) mL,the postoperative exhaust time was (23.5±2.6)h.The patients began to drink water after 6 h and take food after 24 h,recovered and were discharged in 5-7 d after operation.The patients were followed up for 4 to 48 months,the clinical symptoms disappeared and the diet was back to normal after operation. Conclusions: Laparoscopic subtotal cholecystectomy with fenestration for acute cholecystitis can avoid forcible dissection of gallbladder triangle,reduce complications such as bile duct and blood vessel injury.The operation is safe,feasible and effective in the treatment of acute cholecystitis and complex and difficult gallbladder.

关 键 词：胆囊炎 急性 胆囊大部切除术 腹腔镜检查 开窗 

分 类 号：R657.4[医药卫生—外科学]