困难型腹腔镜胆囊切除术的困难原因及处理

Cause and management of difficultly laparoscopic cholecystectomy

目的 :探讨困难型腹腔镜胆囊切除术的困难原因及术中的处理技巧。方法 :回顾性分析 1 0 5例困难型腹腔镜胆囊切除术的临床资料。结果 :困难原因分别为 Calot三角区粘连 89例 (占 84 .6 % ,与以下各原因比较 P<0 .0 5 ) ,胆囊与邻近脏器粘连 2 7例 (占 2 5 .7% ) ,胆囊颈部嵌顿结石 2 0例 (占 1 9.1 % ) ,胆囊肿大 2 3例 (占 2 1 .9% ) ,胆囊炎症充血、水肿、壁增厚≥ 0 .6 cm 1 8例 (占 1 7.1 % ) ,胆囊萎缩 34例 (占 32 .4 % ) ,肝外胆管变异 2 1例 (占 2 0 % ) ,血管变异 2 6例 (占2 4 .8% ) ;其中有 86 .7%的病例合并两种以上的困难原因。成功 1 0 1例 ,成功率 96 .2 % ,无胆管损伤、死亡病例。结论 :Calot三角区粘连为常见困难原因 ;

Objective: To study the cause and management of difficultly laparoscopic cholecystectomy. Methods: A retrospective analysis of 105 difficultly laparoscopic cholecystectomies was performed. Result: Laparoscopic cholecystectomies were successfully performed in 101 cases (96.2%), and no death and bile duct injury occurred. The predictive factors leading to operative difficulty were as follows: Calot triangle adhesion in 89 cases (84.6%), adhesion between gallbladder and nearby organs in 27 (25.7%), incarcerated stones of gallbladder neck in 20 (19.1%), gallbladder enlargement in 23 (21.9%), gallbladder wall thickness ≥0.6 cm in 18 (17.1%), gallbladder atrophy in 34 (32.4%), anatomic variation of extrahepatic bile duct in 21 (20%), and cystic vessel variation in 26 (24.8%); of them, there were two or more factors in 86.7% cases. Conclusion: Calot triangle adhesion is the most common cause resulted in difficultly laparoscopic cholecystectomy, and its reasonable management contributes to the successful operation.