腹腔镜胆囊大部切除术的临床应用体会 (附468例报告).docVIP

腹腔镜胆囊大部切除术的临床应用体会 (附468例报告) 郭欣 吕小慧 陈芦斌 解放军第451医院全军腹腔镜中心 第四军医大学附属西京医院妇产科 X 关注成功！ 加关注后您将方便地在 我的关注中得到本文献的被引频次变化的通知！ 新浪微博 腾讯微博 人人网 开心网 豆瓣网 网易微博 摘????要： 目的 探讨腹腔镜胆囊大部切除术的适应证及临床应用体会。方法 回顾性分析2012年1月-2015年12月解放军第451医院因无法行腹腔镜胆囊切除术而改为胆囊大部切除术的临床病例资料468例。结果 术后无死亡病例发生。7例行腹腔镜胆囊切除术中转开腹胆囊大部切除术, 5例Mirizzi综合征 (I型3例, II型2例) 和456例 (各种原因导致的三角区粘连) 行腹腔镜胆囊大部切除术。术后无严重并发症出现, 16例出现胆瘘, 2例十二指肠瘘, 适当引流后均痊愈。362例随访时间 (21.0±4.9) 个月, 消化不良18例, 右上腹或上腹部不适11例。结论 对于胆囊三角区粘连严重的胆结石患者, 腹腔镜下胆囊大部切除术是安全可行的, 可避免对胆道的损伤, 术中和术后重点观察患者胆瘘情况。 关键词： 腹腔镜胆囊大部切除术; 胆瘘; 粘连; 作者简介：陈芦斌, E-mail:aa175893204@126.com 收稿日期：2016-11-06 Clinical experience of laparoscopic subtotal cholecystectomy (468 cases) Xin Guo Xiao-hui Lü Lu-bin Chen Endoscopic Center of PLA, Chinese PLA 451st Hospital; Department of Gynaecology and Obstetrics, the Fourth Military Medical University; Abstract： Objective To investigate the indication and clinical experience of laparoscopic subtotal cholecystectomy. Methods We performed a retrospective analysis on the clinical data of 468 patients who underwent laparoscopic subtotal cholecystectomy from January 2012 to December 2015. Results There were no deaths. 7 cases that underwent laparoscopic cholecystectomy were converted to open surgery with laparoscopic subtotal cholecystectomy. 5 cases that were diagnosed with Mirizzi syndrome (3 cases with type I and 2 with type II) and 456 cases underwent laparoscopic subtotal cholecystectomy. No severe complication was detected after surgery. 16 cases with biliary leakage and 2 with duodenum leakage. The patients got recovered after a short time of drainage. 362 cases were followed up and the median follow-up time was (21.0 ± 4.9) months. 18 ones were with dyspepsia and 11 ones with upper or right upper discomfort. Conclusion Laparoscopic subtotal cholecystectomy was a safe choice and avoided injury of biliary duct for patients with severe adhesion of calots triangle. The biliary leakage should be mainly observed during and after surgery. Keyword： laparo