摘要
目的探讨复杂腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）中高压冲洗器的使用技巧。方法对2015年1月~7月我科实施的81例复杂LC患者的临床资料进行回顾性分析。29例（常规法组）采用电钩解剖分离胆囊管,52例（高压冲洗器组）采用高压冲洗器解剖胆囊三角。结果高压冲洗器组中2例因胆囊三角致密粘连、三角区解剖结构不清而中转开腹,其余79例均在腹腔镜下完成手术。常规组手术时间平均（64.7±17.1）min,术中出血量平均（5.7±5.9）ml,高压冲洗器组（剔除中转开腹病例）手术时间平均（47.9±14.7）min,术中出血量平均（14.0±16.6）ml,组间比较,高压冲洗器组手术时间更短（t=-5.024,P=0.000）,但出血较多（t=3.198,P=0.002）,差异均有统计学意义（P〈0.01）。两组术后均无胆囊动脉大出血或因术中胆囊动脉出血难以控制而改变手术方式,亦无术后腹腔出血行二次手术者。两组术后恢复良好,无胆漏、残余结石及胆管损伤。结论利用高压冲洗器钝性分离胆囊三角,可快速、安全地辨明三管结构,有效避免损伤胆总管及肝总管。
Objective To discuss the application of high pressure aspirator in complicated laparoscopic cholecystectomy（ LC）. Methods The clinical data of 81 patients received complicated LC during January2015 to July 2015 were analyzed retrospectively. 29 cases were dissected Calot＇s triangle by electric hook and regard as traditional measure group,and 52 cases were by high pressure aspirator and regard as aspirator group.Results A total of 79 cases were completed the LC,other 2 cases of the aspirator group converted to open surgery due to condensing adhesion and unclear dissection of Calot＇s triangle. The operative duration was（ 64. 7 ± 17. 1） min and（ 47. 9 ± 14. 7） min,and the intra-operative blood loss was（ 5. 7 ± 5. 9） ml and（ 14. 0 ± 16. 6） ml in traditional measure group and aspirator group respectively. The operative time was shorter and the blood loss was higher in aspirator group than those in traditional measure group（ P〈0. 01）. All cases were achieved well recovery without gallbladder leakage,residual calculi or biliary duct injury. Conclusion The application of high pressure aspirator can be benefit to identify three tube structures safely and quickly,and can avoid the injury of common bile duct and hepatic duct effectively in difficult laparoscopic cholecystectomy.
出处
《中国现代手术学杂志》
2016年第6期409-411,共3页
Chinese Journal of Modern Operative Surgery
关键词
胆囊切除术
腹腔镜
冲洗器
cholecystectomy
laparoscopic
aspirator
