胆囊动脉免钳夹腹腔镜胆囊切除术.DOCVIP

临床医学论文-胆囊动脉免钳夹腹腔镜胆囊切除术 ?????????? 作者：吴小兵，宋卫林，杨滏宁，侯强，孙彤宇 【摘要】? 目的：探讨腹腔镜胆囊切除术中应用单极电凝而免于钛夹钳夹胆囊动脉的可行性及临床应用价值。方法：１６８例病例采用２人３孔法完成ＬＣ，胆囊管残端钳夹钛夹１枚，单极电凝仔细解剖胆囊三角，组织边凝边切，胆囊动脉“骨骼化”后分段电凝后中间电切离断而不用钛夹钳夹。结果：手术时间１０～２０ｍｉｎ，平均１５ｍｉｎ，手术中出血量５～２０ml,平均１２.５ｍｌ。无副损伤及中转开腹病例。结论：2mm以下的胆囊动脉仅用单极电凝止血而免于钛夹钳夹是安全的。 　　【关键词】? 腹腔镜；胆囊切除术；胆囊动脉；钛夹 　　Laparoscopic cholecystectomy? without clamped cystic artery:with a report of? 168 cases 　　【Abstract】? Ｏbjective:To investigate the feasibility and clinical application value of applying monopole electrocautery to electric coagulate cystic artery but not titanium clips in laparoscopic?cholecystectomy(LC).Methods:168 patients were operated LC wite 3 holes by 2 persons.The stump of cystic duct was clamped with 1 titanium clips ,Calot,s triangle was dissected with monopole electrocautery,tissue around gallblader牋?was electric coagulated and dissected step by step,we cut the cystic artery at the middle site with electrocautery,not clamped with titanium clips,after it was skeletonized and electric coagulated in segmentation.Results:The operations were completed between 10 minutes to 20 minutes,averaged 15 minutes .The bleed volume in operations was beteen 5ml?to牋 20ml ,averaged 12.5ml .There were no deputy injury in all patients and none was open abdomen during LC.Conclusions:It is safety to electric coagulate cystic artery which diameter less than 2mm only with monopole electrocautery but not clamped with titanium clips. 　　【Key words】? Laparoscopy;cholecystectomy;cystic artery;Titanium clips 　　利用钛夹钳夹处理胆囊动脉是腹腔镜胆囊切除术（ＬＣ）最常用的方法。我们借鉴妇科在腹腔镜手术中利用高频电刀单极电凝处理子宫韧带的经验，将单极电凝运用１６８例ＬＣ中处理胆囊动脉而免于利用钛夹钳夹，取得了良好的效果，积累了经验，报告如下。 　　１? 资料与方法 　　1.1? 临床资料? １６８例中男５８例，女１１０例，２３～６７岁，平均４４岁。慢性结石性胆囊炎１０２例，胆囊息肉４３例，慢性结石性胆囊炎急性发作２３例。合并有高血压１２例。 　　1.2? 手术方法? 采用２人３孔法完成ＬＣ，胆囊管残端钳夹钛夹１枚，单极电凝仔细解剖胆囊三角，组织边凝边切，胆囊动脉“骨骼化”后分段电凝后中间电切离断而不用钛夹钳夹。腹腔遗留钛夹共１枚。纱布块擦拭处理胆囊床及胆囊三角。前１０例放置腹腔引流管。 　　２? 结果??? 　　手术时间１０～２０ｍｉｎ，平均１５ｍｉｎ，手术中出血量５～２０ml,平均１２.５ｍｌ。无副损伤及中转开腹病例。１０例放置腹腔引流管者手术次日晨拔管，引流量均少于１０ｍｌ。术后２～３ｄ出院。 　　３? 讨论??? 　　胆道系统的解剖变异多见［