急性胆囊炎腹腔镜胆囊大部切除26例报告 _医学论文.docVIP

急性胆囊炎腹腔镜胆囊大部切除26例报告 _医学论文 急性胆囊炎腹腔镜胆囊大部切除26例报告 _医学论文 【摘要】 目的 探讨急性胆囊炎行腹腔镜胆囊切除术中，遇到胆囊三角区严重粘连时，如何处理胆囊管及避免肝外胆管损伤的办法。方法 从1996年7月至今，共有2362例患者行腹腔镜胆囊切除术，回顾分析总结我科26例腹腔镜胆囊大部切除术的原因、方法、经验和体会。结果 24 例手术顺利完成，2例中转开腹，全无死亡，术中胆总管前壁被电刀点状灼伤1例致术后胆瘘，术后第6 天自行闭合。手术时间25～160min，平均105min。术中出血5～70ml，平均45ml。术后3～11 天痊愈出院，平均6.46天。随访3个月～3年，无症状复发，效果满意。结论 在化脓性胆囊炎或胆囊三角严重粘连疤痕化等不能够常规行胆囊切除的病人，行腹腔镜胆囊大部分切除术简便而安全可行，不但能够达到胆囊切除的目的，又能减少肝外胆管和血管损伤，避免了中转开腹但必须严格掌握适应证，正确处理胆囊残余部分。 【关键词】 腹腔镜胆囊大部切除术胆囊切除术胆囊炎 Analysis of laparoscopic partial cholecystectomy for 26 cases of acute cholecystitis 【Abstract】 Objective To explore handling measures of deal with ductus cysticus and avoiding extrahepatic bile duct to be impaired while Calot triangle severe adherence as acute cholecystitis in laparoscopic cholecystectomy.Methods 2362 cases who underwent laparoscopic cholecystectomy from July 1996 to now were collected and analyzed retrospectively. Twenty-six of them were performed partial cholecystectomy.Results Operation(24 cases) went on smoothly, conversion to open 2 cases.There were no cases of mortality. And common bile duct of anterior wall (1 cases) was injuried by electrode knife in operation,and it caused bile leak after operation.After 6 days， bile leak stoped. The mean operative time was 105 min (range，25～160min). The mean blood loss was 45ml (range，5～70ml ). The average time of hospitalization after operation was 6.46 days (range， 3～11 days). Follow - up lasted three months to three years. Their clinical manifestations had no recurrence. All 24 cases got satisfied effect.Conclusion It is a simple safe and feasible method. It can decrease the rate of external hepatic biliary ducts injury and avoid converting to open laparotomy. We must strictly master the indication and manage residue of cystic duct correctly. 【Key words】 laparoscope； partial cholecystectomy；cholecystectomy； cholecystitis 急性胆囊炎由于胆囊三角周围组织炎症水肿重或瘢痕粘连，正常的组织结构不易辨别，盲目解剖胆囊三角区，极易损伤胆总管、右肝管及门静脉。采用胆囊部分切除术，可以有效防止胆管损伤和出血， 且无明显后遗症，我科自1996 年7 月开展腹腔镜胆囊切除术(laparoscopic