腹腔镜手术治疗嵌顿性胆囊结石235例分析

Laparoscopic cholecystectomy performed in 23 5 casesof cholecystitis with impacted gallstones

本文报告我院近２年２３５例嵌顿性胆囊结石的腹腔镜手术治疗经验，研究了急性和慢性嵌顿性胆囊结石的诊断、分型和处理方法。全组慢性嵌顿性胆囊结石２２１例，急性嵌顿性胆囊结石１４例，占同期腹腔镜胆囊切除术总数（１４７５例）的１５．９％。９例中转开腹手术，其中７例为胆囊周围或ｃａｌｏｔ三角严重粘连，１例为急性坏疽性胆囊炎、１例为结石嵌顿于胆囊管与肝总管交界部，中转开腹率３．８％。术后并发胆瘘２例，经引流自行愈合，全组无腹腔感染及死亡。

Abstract During the past 2 years,235 cases of cholecvstitiswith impacted gallstones were treated with laparoscop-ic technique. There were 221 chronic cases and 14 a-cute cases accounting altogether for 1 5.19%of a totalof 1475 patients undergoing laparoscopic cholecystec-tomy during the same period.As a result, 9 of thesepatients were converted to open surgery.Severe adhe-sion around the gallbladder or/and in the Calot trianglein 7,acute impacted gallstone,gallbladder necrosis a-long with obscure anatomy in the calot triangle in 1,and gallstone impacted at the junction of the commonhepatic and cystic duct in 1 were observed.Conversionrate was 3.8%. Postoperative bile leakage developedin 2 cases and healed spantaneously.There were no in-traperitoneal sepsis and perioperative death in our pat-ints. The diagnosis,classification,and managementfor acute or chronic impacted gallstone are discussed.