精细解剖预防腹腔镜胆囊切除并发症临床观察.docVIP

精细解剖预防腹腔镜胆囊切除并发症临床观察 　　【摘要】 目的 探讨精细解剖预防腹腔镜胆囊切除并发症的临床价值。方法 回顾性分析158例行腹腔镜胆囊切除术患者的临床资料， 全部患者术中均采用精细解剖的方法， 统计患者的手术时间、手术并发症情况及住院时间等。结果 158例患者均获手术成功， 手术时间（70.8±26.1）min， 住院时间（4.2±2.7）d。其中2例术中发现为Mirizzi综合征， 局部粘连严重， 解剖不清， 中转开腹；其余156例患者全腔镜完成， 三孔法93例， 四孔法63例。放置腹腔引流管42例， 其中1例术中胆囊床大出血， 考虑肝中静脉分支损伤， 腔镜下用4/0血管缝线缝扎止血， 未中转开腹；其余患者无胆管损伤及术后胆漏、出血等并发症发生。随访3～26个月， 患者无肝功能异常、胆管狭窄等。结论 精细解剖可有效预防腹腔镜胆囊切除术相关并发症， 值得临床推广。 　　【关键词】 精细解剖；腹腔镜胆囊切除术；并发症 　　DOI：10.14163/j.cnki.11-5547/r.2018.06.009 　　【Abstract】 Objective To investigate the clinical value of fine anatomy in the prevention of complications of laparoscopic cholecystectomy. Methods The clinical data of 158 patients with laparoscopic cholecystectomy was retrospective analyzed. All patients underwent fine anatomy during operation， and their operative time， operative complications and hospitalization time were statistically analyzed. Results All the 158 cases were successfully operated， with operation time as （70.8±26.1） min， hospitalization time as （4.2±2.7） d. Among them， Mirizzi’s syndrome was found in 2 cases， with severe local adhesions， unclear anatomy and laparotomy conversion. The other 156 cases were completed by endoscopy， 93 with three-hole method and 63 with four-hole method. Abdominal cavity drainage tube was placed in 42 cases， including 1 case of massive hemorrhage of gallbladder bed during operation， considering hepatic vein branch injury， endoscopic hemostasis with 4/0 suture 　　and no conversion to laparotomy. The other patients had no bile duct injury， postoperative biliary leakage， bleeding and other complications. After 3～26 months of follow-up， patients have no liver function abnormality and bile duct stricture. Conclusion Fine anatomy can effectively prevent related complications of laparoscopic cholecystectomy， and is worthy of clinical promotion. 　　【Key words】 Fine anatomy； Laparoscopic cholecystectomy； Complications 　　腹腔?R胆囊切除术（laparoscopic cholecystectomy， LC）经过30余年的发展已成为治疗胆囊良性疾病的主要方法， 目前国内大部分二级以上医院均可开展。研究报道腹腔镜胆