直视下建立气腹行腹腔镜胆囊切除术  

Laparoscopic cholecystectomy by establishing pneumoperitoneum under direct vision

作　　者：沈军[1] 陈大伟[1] 董谦[1] 翁志毅[1] 费哲为[1] 

机构地区：[1]上海第二医科大学附属新华医院普外科,上海200092

出　　处：《中国普通外科杂志》2002年第10期587-588,共2页China Journal of General Surgery

摘　　要：目的　探讨直视下建立气腹行腹腔镜胆囊切除术 (LC)的方法及优点。方法　于脐孔下缘作一长约 1cm的切口 ,直视下于腹白线处提起腹膜切开 ,插入 10mmtrocar建立气腹 ,再置入腹腔镜。结果　 10 7例LC患者中慢性胆囊炎胆囊结石 93例 ,急性胆囊炎胆囊结石 6例 ,胆囊息肉 8例。有下腹部手术史者 16例 ,中转开腹 2例 ,均因萎缩性胆囊炎胆管解剖不清楚。手术时间平均 45min。术后并发肺部感染 3例、胆瘘 1例 (钛夹脱落所致 ) ,无胆管损伤等其他严重并发症发生 ,无 1例死亡。结论　应用直视下建立气腹的优点是安全快捷 ,并可防止严重的trocar相关性并发症。Objective To determine the advantages of laparoscopic cholecystectomy (LC) by establishing pneumoperitoneum under direct vision. Methods A 1cm incision was made just below the umbilicus; lifting and cutting out of the peritoneum at the line alba abdominis with direct vision; then a 10mm trocar was inserted into the pneumoperitoneum cavity.Results There were 107 patients underwent LC.Of them, 93 patients suffered from chronic cholecystitis with gallstone, 6 from acute cholecystitis with gallstone, and 8 from cystopolyps. Among them, 16 patients had previous abdominal operations. Two patients with atrophic cholecystitis converted to open cholecystectomy(OC) owing to the unclear bile duct anatomy. The average operation time was 45min. Postoperative complications included pulmonary infection in 3 patients, bile leakage in 1( due to the titanic clip falling off),but no bile duct injury or other severe complications occurred;and no mortality in this series. Conclusions Establishing pneumoperitoneum under direct vision has following advantages:rapid and safe,and favorable to avoid the severe trocar-related complications.

关 键 词：腹腔镜胆囊切除术 人工气腹 手术方法 并发症 

分 类 号：R657.4[医药卫生—外科学]