胆囊急性炎症期LC体会

EXPERIENCE OF LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CHOLECYSTITIS

目的 总结急性炎症期腹腔镜胆囊切除术(L C)的临床经验。方法 对我院4 6例结石性胆囊炎急性炎症期行L C术的临床资料进行回顾性分析总结。结果 4 6例L C操作,除11例中转开腹外(2例胆管损伤、1例Mirizzi综合症、1例胆囊十二指肠瘘、7例胆囊三角“胼胝样”粘连,无法保证胆管不损伤) ,其余均在腹腔镜下完成,手术时间5 0 min～16 0 m in(75 .0±2 0 .5 m in)。3例术后出现胆漏,其中1例术后四天开腹探查(当时未放引流)、另2例经双套管持续负压引流后治愈。切口感染4例,术后住院时间5～8天。结论 结石性胆囊炎急性炎症期并非L C禁忌症。手术操作耐心、解剖仔细、适时中转,可降低并发症的发生。

Objective To summarize the clinical experience of laparoscopic cholecystectomy(LC)in acute cholecystitis. Methods Clinical data from 46 cases by LC in acute calculous cholecystitis were retrospectively analysed.Result 46 cases of acute calculous cholecystitis were treated with LC, of which 11 cases were changed to open cholecystectomy (2 cases were because of biliary duct injury, 1 of Mirizzi′s syndrome, 1 of cholecyste-duct and duodenum-duct leak, 7 of adhesion around gallbladder and unclear discrimination of Calot's triangle.).Bile leakage occurred in 3 cases, of which 1 case was reoperated on the 4th day after operation(no intra-abdominal drainage then), and the other two cases were cured successfully by the persistent belly cavity drainage. Infection of incisional wound occurred in 4 cases. Length of hospital stays were 5 to 8 days. Conclusion LC in patients with acute cholecystitis is possible to perform. Complication could be reduced through operating cautiously, anatomizing carefully and transferring to open operation if necessary.