腹腔镜治疗胆囊结石预防胆管损伤的两种安全策略  

Two prevention strategies for preventing bile duct injury in laparoscopic surgery for cholecystolithiasis

作　　者：尚培中[1] 李晓武[1] 苗建军[1] 刘冰[1] Shang Peizhong;Li Xiaowu;Miao Jianjun;Liu bing(Department of General Surgery,The Hospital of PLA 81st Group Army,Hebei 075000,China)

机构地区：[1]中国人民解放军陆军第81集团军医院普通外科,张家口075000

出　　处：《中华普外科手术学杂志（电子版）》2021年第3期255-258,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：河北省科技支撑计划项目(11276103D-21)。

摘　　要：为避免腹腔镜治疗胆囊结石发生胆管损伤,提出了两种安全的手术策略。对非困难胆囊应用壶腹钟表定位法作导航仪,高度警惕易发生胆总管横断损伤的9~12点区位壶腹和高位肝管损伤的3点区位壶腹,以胆囊颈部为警界,顺沿颈部游离并妥善处理胆囊管。对困难胆囊实施经典手术风险较高时,树立胆囊废弃术理念,把追求胆囊完整切除的单一思维拓展为综合运用多种技术,把单纯一种“去除脏器”治疗模式变为多种途径“废除功能”的三步曲治疗模式。In order to prevent bile duct injury in laparoscopic surgery for cholecystolithiasis,two safe surgical strategies were proposed.For the non-difficult gallbladder,the ampullary clock positioning method was used as the navigator.High vigilance was given to the ampullary at 9 points to 12 points and the ampullary at 3 points of high hepatic duct injury,and the neck of the gallbladder was taken as the warning boundary,the cystic duct was disintegrated along the neck and properly handled.For the difficult operative conditions with high risk,we applied the laparoscopic gallbladder disabled technique by the three-step treatment mode instead of complete removal of the gallbladder as a whole viscera.

关 键 词：胆囊炎 胆囊结石病 胆囊切除术 腹腔镜 胆囊壶腹钟表定位法 胆囊废弃术 

分 类 号：R65[医药卫生—外科学]