腹腔镜困难胆囊切除的体会  

Experience in removing the complicated gallbladder through laparoscopic cholecystectomy

作　　者：张扬[1] 魏尚典[1] 黎有典[1] 张克兰[1] 丁建忠 

机构地区：[1]常德市第一人民医院,湖南常德415000 [2]常德市第五医院

出　　处：《腹腔镜外科杂志》2003年第3期140-141,共2页Journal of Laparoscopic Surgery

摘　　要：目的 :探讨腹腔镜困难胆囊切除的方法 ,预防胆管损伤 (BDI)并发症的发生。方法 :回顾LC切除困难胆囊 2 71例的临床资料。结果 :困难胆囊切除 2 71例中 ,右肝管损伤 1例 ,肝总管部分夹闭 1例 ,胆囊管结扎成角 1例 ,胆囊床迷走胆管漏 1例 ,术后胰腺炎 1例 ,肝下积液 1例 ,戳孔感染 4例。行胆囊造瘘 2例 ,中转开腹 3例 ,放置引流管 31例。 3例胆管损伤再次开腹处理 ,胆管并发症为 1 1%。其它均保守治疗 ,术中发现经处理均痊愈。结论 :腹腔镜困难胆囊切除与术者的手术经验相关 ,既可多种方法并用 ,也可单用一种方法 ,要严格掌握适应证及中转手术的时机 ,合理使用器械 。Objective:To study the methods for removing the complicated gallbladder through laparoscopy and preventing the accurence of complications of bile duct injury.Methods:271 cases complicated gallbladder were removed by laparoscopes with both the usual and unusual ways.Results:271 cases complicated gallbladder were removed by laparoscopy.One was with right hepatic duct damaged.One was with angulation of the gallbladder duct while ligated.One was with aberrant biliary ducts transudation of the gallbladder bed.One was with pancreatitis.One was with subhepatic hydrops.Four were infected by poking holes(diabetics).Two cases undertook biliary fistula operation.Three transferred to open operation.Thirty one put in draining tubes.Three cases cut open twice for the BDI.The rest were all with conservative treatment and recovered completely after being handled during the operation when the problem appeared.Among the 271 cases with complicated gallbladder operations,three were BDI.The biliary duct complication was 1 1%. Conclusions:The removing operation of complicated gallbadder with laparoscopy has much relation with the doctors' experience.The doctors should pay attention to accumulate the experience.Mult ways at one time or single one are both available.But the indications must be controlled and when can be transferred to open operation and using the instruments reasonably and making good preparations at the pre post operation are most important.

关 键 词：腹腔镜 胆囊切除术 胆囊疾病 并发症 预防 

分 类 号：R657.4[医药卫生—外科学]