腹腔镜胆囊大部切除胆囊管旷置术在急性化脓性胆囊炎中的应用  

Application of laparoscopic subtotal cholecystectomy with ductus cysticus open in acute suppurative cholecystitis

作　　者：黄倩倩[1] 王亚栋 徐倩倩[2] 刘凤悦[2] HUANG Qian-qian;WANG Ya-dong;XU Qian-qian(Department of Orthopedic Surgery,Qilu Hospital of Shandong University,Jinan 250012,China;Department of Organ Transplantation,Qilu Hospital of Shandong University)

机构地区：[1]山东大学齐鲁医院骨外科,山东济南250012 [2]山东大学齐鲁医院器官移植科

出　　处：《腹腔镜外科杂志》2021年第8期627-629,共3页Journal of Laparoscopic Surgery

摘　　要：目的:总结腹腔镜胆囊大部切除胆囊管旷置术治疗急性化脓性胆囊炎的临床疗效及安全性。方法:回顾分析2011年11月至2021年1月行腹腔镜胆囊大部切除胆囊管旷置术的34例急性化脓性胆囊炎患者的临床资料,总结分析手术时间、中转开腹情况、术中出血量、术后带引流管时间、术后住院时间及术后并发症等指标。结果:34例患者中男20例,女14例;14例病程<72 h,20例病程超过72 h。手术均顺利完成,无一例中转开腹。手术时间55~175 min,平均(119.7±32.91)min;术中出血量10~60 mL,中位出血量25(10,30)mL;术后住院2~9 d,中位住院时间3(2,5.25)d;术后带管时间2~30 d,中位带管时间7.5(3,10)d。术后发生胆漏6例(17.6%),未发生结肠损伤、十二指肠损伤、肝脏损伤、胆管损伤等其他手术相关并发症。结论:急性化脓性胆囊炎行腹腔镜胆囊大部切除胆囊管旷置术是安全、可行的。Objective:Acute suppurative cholecystitis may cause severe complications such as gallbladder perforation and septic shock if not treated in time.Traditional laparoscopic cholecystectomy is easy to cause common bile duct injury.The purpose of this study was to analyze the safety of laparoscopic subtotal cholecystectomy with open ductus cysticus in the treatment of acute suppurative cholecystitis.Methods:The clinical data of all patients with acute suppurative cholecystitis who underwent laparoscopic subtotal cholecystectomy with open gallbladder duct from Nov.2011 to Jan.2021 were retrospectively analyzed.The following evaluation indexes were summarized and analyzed:the operation time,conversion to laparotomy,intraoperative blood loss,postoperative drainage tube time,postoperative hospital stay and postoperative complications.Results:A total of 34 patients were included in this study.There were 20 male patients and 14 female patients.There were 14 patients with a medical history within 72 h,and 20 patients with a medical history over 72 h.Nineteen had received antibiotics before surgery and 15 had not received any antibiotics.All the operations were successfully completed without conversion to laparotomy.The mean operation time was(119.7±32.91)min(range,55-175 min);the median intraoperative blood loss was 25(10,30)mL(range,10-60 mL);the median postoperative hospital stay was 3(2,5.25)d(range,2-9 d);and the median postoperative catheterization time was 7.5(3,10)d(range,2-30 d).Biliary leakage occurred in 6 patients(17.6%)without other surgical complications such as injury of colon,duodenum,liver or bile duct.Conclusions:Laparoscopic subtotal cholecystectomy with open gallbladder duct is a safe and feasible surgical method for acute suppurative cholecystitis.

关 键 词：急性化脓性胆囊炎 胆囊大部切除术 腹腔镜检查 胆囊管处理 

分 类 号：R657.4[医药卫生—外科学]