腹腔镜困难胆囊切除术的手术策略分析  

Operative strategy of difficult laparoscopic cholecystectomy

作　　者：王毅 刘杰 WANG Yi;LIU Jie(Department of Hepatobiliary and Pancreatic Surgery,Guilin People’s Hospital,Guilin 541002,China)

机构地区：[1]桂林市人民医院肝胆胰外科,广西桂林541002

出　　处：《腹腔镜外科杂志》2021年第9期683-686,690,共5页Journal of Laparoscopic Surgery

摘　　要：目的:探讨腹腔镜困难胆囊切除术的手术策略。方法:回顾分析2016年1月至2020年4月为124例患者行腹腔镜困难胆囊切除术的临床资料。结果:123例手术获得成功,1例因合并门静脉高压症术中出血量较大难以控制而中转开腹。手术时间54~160 min,中位数70.5 min;术中出血量20~500 mL,中位数50 mL,均未输血。患者均留置腹腔引流管,术后引流量20~520 mL,中位数50 mL,引流液颜色均为淡红色,留置时间2~6 d,中位数3 d。术后住院2~10 d,中位数3 d。无术后大出血,2例发生胆漏,引流量均较小,经引流后治愈出院。无胆管横断等不可逆胆道损伤。结论:腹腔镜困难胆囊切除术中采用最后切断胆囊管及胆囊动脉、胆囊部分切除、胆囊切开减压等方法,利于减少术中胆道损伤,增加了手术安全性。Objective:To explore the operative strategy of difficult laparoscopic cholecystectomy.Methods:A retrospective analysis was made on the clinical data of 124 patients who underwent difficult laparoscopic cholecystectomy between Jan.2016 and Apr.2020.Results:Laparoscopic cholecystectomy was successful in 123 patients.One case which combined with portal hypertension was converted to laparotomy because of uncontrollable massive hemorrhage.Operative time was 54-160 min,and the median was 70.5 min.Estimated blood loss was 20-500 mL,and the median was 50 mL,no case has blood transfusion.All cases retained abdominal drainage tube,postoperative drainage volume was 20-520 mL,and the median was 50 mL,the color of drainage was light red.The drainage tube was removed after 2-6 d,the median was 3 d.Postoperative hospital stay was 2-10 d,the median was 3 d.No massive hemorrhage occurred after operation.2 patients of bile leakage with small amount of leakage were cured after drainage and discharged.There was no irreversible biliary injury such as bile duct transection.Conclusions:In difficult laparoscopic cholecystectomy,it is helpful to reduce incidence of biliary injury and make operation safer by cutting the cystic duct and the cystic artery in the end,as well as subtotal cholecystectomy and gallbladder decompression.

关 键 词：胆囊切除术 腹腔镜 胆道损伤 胆囊部分切除术 

分 类 号：R657.4[医药卫生—外科学]