摘要
目的:探讨腹腔镜复杂胆囊切除术中胆囊切开引导胆囊管的重要性及处理方法。方法选取50例腹腔镜复杂胆囊切除术患者并按入院顺序随机分为常规组(常规行腹腔镜胆囊切除术)和实验组(术中采用胆囊切开引导胆囊管)各25例,其中实验组先切开胆囊壶部或体部,先将胆汁吸净,将结石取出,辨认胆囊管的开口,采用钛夹夹闭胆囊管(胆囊管可完全分离)或于腹腔镜下缝扎胆囊管断端(胆囊管紧贴胆总管难以分离)。观察两组患者手术情况及肝外胆管损伤发生率。结果两组患者术后均无切口感染、腹腔感染及出血等并发症的发生,术后引流2~3 d,常规组患者中1例引流出胆汁样液体,延长引流时间至1周。实验组手术时间、术中出血量、住院时间、住院费用、引流量及肝外胆管损伤均低于常规组,两组比较差异具有统计学意义(P〈0.05)。结论复杂腹腔镜胆囊切除术中采用胆囊切开引导胆囊管可明显降低手术难度,缩短手术时间,减少手术创伤,且具有较好的安全性和可行性。
Objective To explore the importance and treatment of the guide to the cystic duct through gall-bladder incision in the complex laparoscopic cholecystectomy. Methods Fifty patients underwent the complicated laparoscopic cholecystectomy were randomly divided into routine group (routine laparoscopic cholecystectomy) and experimental group (patients with gallbladder incision guided cystic duct), with 25 cases in each group. In the experi-mental group, gallbladder ampulla or body part was incised, and the bile was absorbed, and then the calculus of cystic duct was removed and the opening was recognized. If gallbladder tube can be completely separated, the titanium clip-ping was used;if the common bile duct cystic duct is difficult to separate, laparoscopic suture of cystic duct stump was employed. The operation efficacy and extrahepatic bile duct injury rate were observed in two groups. Results The patients in two groups had no abdominal infection, bleeding complications and incision infection, and drainage was re-move 2~3 d after operation. One case in the routine group occurred drainage bile sample liquid, and drainage time was prolorged to 1 week. In experimental group, operation time, amount of bleeding, hospitalization time and cost, drainage and extrahepatic bile duct injury were lower than those in the routine group (all the P〈0.05). Conclusion The com-plex laparoscopic cholecystectomy gallbladder incision guided by the cystic duct can significantly reduce the difficul-ty of operation, shorten operation time and reduce the operation trauma, with safety and applicability.
出处
《海南医学》
CAS
2014年第14期2145-2147,共3页
Hainan Medical Journal
关键词
胆囊切开
复杂
腹腔镜
胆囊切除术
Gallbladder incision
Complex
Laparoscopy
Cholecystectomy