腹腔镜胆囊切除术治疗合并胆囊管结石嵌顿的急性胆囊炎疗效观察  

Effect of laparoscopic cholecystectomy for acute cholecystitis with gallstone incarcerated in cystic duct

作　　者：吴永哲[1] 李华志[1] 吴畏[1] 郭春海[1] 许臣 佟凡 崔宏力[1] WU Yong-zhe;LI Hua-zhi;WU Wei(Department of General Surgery,Beijing Chuiyangliu Hospital,Beijing 100022,China)

机构地区：[1]北京市垂杨柳医院普通外科,北京100022

出　　处：《腹腔镜外科杂志》2022年第10期791-794,共4页Journal of Laparoscopic Surgery

摘　　要：目的:总结腹腔镜胆囊切除术(LC)治疗合并胆囊管结石嵌顿的急性胆囊炎的临床经验。方法:回顾分析2016年1月至2022年4月收治的37例合并胆囊管结石的急性胆囊炎患者的临床资料,患者均行急诊LC,术中采用不同方法处理嵌顿结石、闭合胆囊管,分析术中处理方法及术后并发症情况。结果:37例均顺利完成LC,无中转开腹;手术时间45~130 min,平均(72.0±20.6)min;出血量10~150 mL,平均(33.0±29.0)mL;术后住院4~10 d,平均(5.2±1.4)d。术后共发生胆管并发症4例(10.8%),其中胆漏2例、胆总管结石1例、胆总管结石伴迟发胆漏1例;术后剑突下切口感染2例(5.4%);并发症经积极处理后患者均痊愈出院。术后病理报告示急性化脓性胆囊炎26例,急性坏疽性胆囊炎11例。结论:LC治疗合并胆囊管结石嵌顿的急性胆囊炎是安全、有效的。Objective:To summarize the clinical experience of laparoscopic cholecystectomy(LC)in the treatment of acute cholecystitis with gallstone incarcerated in cystic duct.Methods:Clinical data of thirty-seven patients who were diagnosed with acute cholecystitis and gallstone incarcerated in cystic duct from Jan.2016 to Apr.2022 were retrospectively analyzed.All patients were t reated with emergency LC.Different methods were used to treat the incarcerated stones and close the cystic duct during the operation.The intraoperative treatment methods and postoperative complications were analyzed.Results:All cases successfully completed LC w ithout conversion to laparotomy.The operation time was 45-130 min with the mean of(72.0±20.6)min;blood loss was 10-150 mL,the mean was(33.0±29.0)mL;the hospitalization time was 4-10 d,with the mean of(5.2±1.4)d.There were 4 cases(10.8%)of biliary complications,including 2 cases of bile leakage,1 case of common bile duct stone,and 1 case of choledocholithiasis with delayed bile leakage.There were 2 cases(5.4%)of subxiphoid incision infection.All patients with complications recovered after active treatment.There were 26 cases(70.3%)of acute suppurative cholecystitis and 11 cases(29.7%)of acute gangrenous cholecystitis a ccording to postoperative pathological report.Conclusions:LC is a safe and effective operation for the treatment of acute cholecystitis with gallstone incarcerated in cystic duct.

关 键 词：胆囊炎 急性 胆囊管结石 胆囊切除术 腹腔镜 

分 类 号：R657.4[医药卫生—外科学]