胆囊嵌顿结石腹腔镜手术的探讨

Evaluation of Laparoscopic Cholecyctectomy for Impacted Stone in Gallbladder

目的:探讨胆囊嵌顿结石腹腔镜胆囊切除术的方法。方法:527例行腹腔镜胆囊切除术患者中嵌顿结石58例(11%),在气管插管静脉复合麻醉下行腹腔镜胆囊切除术。结果:嵌顿结石的平均手术时间(110±31)min较非嵌顿者(60±25)min显著延长(P<0.05);平均出血量(120±100)g较非嵌顿者(30±16)g显著增加(P<0.05);中转开腹手术明显增多;术后有2例存在残留结石。结论:对于胆囊嵌顿结石,应用腹腔镜治疗要严格掌握适应症,对于三管合流部炎症较重,而解剖需要60min以上的病例,以及嵌顿结石的位置无法确认或术野展开困难的病例,应及时中转开腹手术。

Objective To explore the technical aspects, efficacy, and complications of laparoscopic cholecystectomy（LC） in patients with impacted gallstones and non-impacted gallstones. Methods Clinical data of 527 patients who underwent a LC between 2000 to 2003 were analyzed. Results In this series 58 （ 11% ）were diagnosed with impacted gallstone. The mean operation time for impacted gallstone was longer than that for non-impacted gallstone（ 110 ± 31min vs 60 ± 25min, P 〈 0.05）. Mean blood loss was significantly greater for impacted gallstone than for non - impacted gallstone（ 120 ± 100g vs 30 ± 16g, P 〈 0.05） Eleven patients（ 19% ） with impacted gallstone required conversion to open procedure, while 1 （0.2%） patient with non-impacted gallstone required it（ P 〈 0.05）. Mean time for the conversion was 48 ± 33min in patients of impacted gallstone. In 10 cases, inflammatory changes during the operation led to technical difficulties that required conversion to open procedure. Complications of remnant gallstones were found in 2 patients.Conclusion LC is possible in patients with impacted gallbladder. If there is severe inflammatory in the Calot triangle and difficulty in identification of impacted gallstone then prompt determination of conversion to open procedure should be made. It is important to prevent complications of remnant gallstones and to identify preoperatively the position and the number of the impacted gallstones.