摘要
目的探讨浆膜下处理胆囊动脉的腹腔镜胆囊切除术在临床中的应用价值。方法回顾性分析2008年1月～2011年10月169例实施浆膜下处理胆囊动脉的腹腔镜胆囊切除术患者的临床资料,术中离断胆囊管后紧贴胆囊壁肌层平面顺行分离,于胆囊浆膜下处理胆囊动脉进入胆囊壁的分支,游离切除胆囊。胆囊动脉的处理:电钩梯度电凝113例,超声刀处理39例,Ligasure处理8例,钛夹5例,4例胆囊动脉与胆囊管伴行,处理上胆囊动脉与胆囊管一并用Hem-O-Lok夹闭。结果全组病例均在腹腔镜下完成手术,其中8例继而行胆总管切开取石,T管引流术,手术时间25～205min,平均43min;术中出血量5～250mL,平均10mL,术中解剖Calot三角内胆囊动脉至肝右动脉65例,余104例仅解剖其分支,未追求其来源。术后住院时间1～12d,平均4.3d,术后随访2～18个月,平均随访8月,全组无腹腔出血、胆管损伤等并发症。结论浆膜下处理胆囊动脉的腹腔镜胆囊切除术更符合安全、微创的理念,是一种合理的手术方式,值得在临床推广。
Objective To evaluate the effect of the way of subserosal cut off cystic artery on laparoscopic cholecystectomy. Methods From January 2008 to October 2011, a total of 169 patients underwent LC through using a method of subserosal cut off cystic artery branch during operation. Treatment of the cystic artery included coagulation hook in 113 cases, ultrasonic Scalpel in 39 cases, Ligasure in 8 cases, titanium clip in 5 case and clip with Hem-O-Lok in 4 cases in which the cystic artery lined with the cystic duct was clipped together with the lined cystic duct. Results The procedure was completed in all of 169 of the cases under laparoscope in which 8 cases underwent laparoscopic common bile duct exploration and T tube drainage of common bile duct at the same time. The operation time ranged from 25 to 205 min （mean,43 rain）. Blood loss ranged from 5 to 250 mL （mean, 10 mL）. In these 169 cases, the cystic artery were separated to the right hepatic artery in 65, and the other 104 were only dealed with the branches of cystic artery. Postoperative hospital stay was ranged from 1 to 12 days （mean,4.3 days）. All patients were followed up for 2 to 18 months （mean, 8 months）. No abdominal hemorrhage or biliary injury occurred. Conclusions Subserosal treatment of cystic artery for laparoscopic cholecystectomy is more consistent with the concept of security and minimal invasion, and it worth being recommend as a promising technique for the operation.
出处
《岭南现代临床外科》
2012年第3期171-172,175,共3页
Lingnan Modern Clinics in Surgery
关键词
胆囊切除术
腹腔镜
胆囊动脉
Cholecysteetomy
Laparoscopy
Cystic artery
