腹腔镜胆囊大部切除术的临床应用体会.docxVIP

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 属西京医院妇产科 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 腔镜胆囊切除术屮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例出现胆痿，2例十二指肠痿，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，术屮和术后重点观察患者胆痿情况。 关键词： 腹腔镜胆囊大部切除术;胆痿;粘连; 作者简介：陈芦斌，E-ma订:aa126. com 收稿日期：2016-11-06 Clinical experience of laparoscopic subtotal cholecystectomy （468 cases） Xin Guo Xiao-hui Lti Lu-bin Chen Endoscooic Center of PLA, Chinese PLA 451st Hospital; Department of Gynaecology and Obstetrics, the Fourth Military Medical University; Abstract： Objective To invcstigatc the indication and clinical expcricncc 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 cholccys tcctomy were converted to open surgery with laparoscopic sub total 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 bi 1iary 1eakage and 2 with duodenum 1eakage. 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. Conelusion Laparoscopic subtotal cholecystectomy was a safe choice and avoided injury of bi 1iary duct for patients with severe adhesion of calot s trianglc. The biliary leakage should be mainly observed during and after surgery. Keyword： laparoscopic subtotal cholecystectomy; biliary leakage; adhesion; Received： 2016-11-06 R前公认的治疗胆囊良性疾病的金标准是腹腔镜胆囊切