摘要
目的总结腹腔镜手术治疗急性结石性胆囊炎的经验。方法对508例行腹腔镜胆囊切除术的急性结石性胆囊炎患者的临床资料进行回顾性分析。结果508例中498例完成腹腔镜胆囊切除术,其中5例加行腹腔镜下胆总管探查T管引流术。即刻中转开腹手术10例,占1.97%。原因分别为Calot三角冰冻样粘连6例;术中疑有胆管损伤3例;术中出血不能控制1例。手术时间25～120min。渗血、渗液较多时常规于温氏孔放置引流管。并发症包括:切口感染3例;脐部切口疝1例;严重皮下气肿5例。全组无胆管损伤、胆漏、腹腔出血等严重并发症。无死亡病例。平均住院时间9.15d。结论发作时间不应成为能否施行LC手术的限制,根据术者的实际技术水平采取"个体化"的方式选择急性结石性胆囊炎手术适应证,分别采用顺行、逆行或顺逆结合的方式完成手术,采取由简到难,逐步扩展手术时机的步骤,术者量力而行掌握中转开腹指征是提高手术成功率、保证手术安全的关键。
[Objective] To summarize LC treatment for acute calculous cholecystitis. [Methods] The clinical data of 508 cases were analyzed retrospectively. [Results] 498 cases had LC with no serious complications, of which 5 cases had both LC and common bile duct exploration T- tube drainage. 10 cases were converted to immediate laparotomy （1.97%）, for Calot triangle adherence （6 cases）, suspectable bile duct injury （3 cases） and uncontrollable hemorrhage （1 case）. The operation time ranged from 25 to 160 minutes. Drainage tube was placed in omental foramen when more errhysis or effusion noticed. Complications were： infection of incisional wound （3 cases）; umbilical incisional hernia （1 case）; severe pneumodemla （5 cases）. No severe complications as bile duct injury, biliary leak, abdominal cavity hemorrhage was found. No death case reported. The mean hospitalization time was 9.15 d. [Conclusion] Paroxysm time should not be the only determinant of LC performance, individualized acute calculous cholecystitis indications should be chosen on the strength of technicians＇ technical level. With anterograde, retrograde or antergrade-retrograde-combined technique can be applied, operator should perform operation step by step and pay attention to laparotomy indications so as to ensure patient＇s safety and a successful operation.
出处
《中国内镜杂志》
CSCD
北大核心
2008年第3期322-324,329,共4页
China Journal of Endoscopy
关键词
急性结石性胆囊炎
腹腔镜胆囊切除术
acute calculous cholecystitis
laparoscopic cholecystectomy
