直视微创小切口胆囊切除术380例诊治体会

Open Cholecystectomy via Mini-incision (with a Report of 380 Cases)

目的探讨直视微创小切口胆囊切除术的可行性及其疗效。方法对380例单纯胆囊疾病患者行直视微创小切口胆囊切除术,切口2.5～4.0cm。结果12例扩大切口行常规开腹手术,其中7例胆囊周围粘连严重,1例胆囊动脉出血,2例术中轻微误伤胆总管而加行T管引流,1例损伤肝总管而改行Roux en Y胆肠内引流,1例发现为胆囊癌而改行胆囊切除加区域淋巴结清扫术。术后发生胆漏5例,经放置腹腔引流管外引流3～7d停止。术后平均随访6个月,2例因胆囊管残余结石而再次手术。结论微创切口胆囊切除手术切口小、损伤小、恢复快,如果病人选择合适,是一种安全可行的手术。

Objective To investigate the feasibility and therapeutic effect of open cholecystectomy via mini-incision. Method 380 cases underwent open cholecystectomy via mini-incision with length of 2.5 to 4.0 cm. Result 12 cases underwent extension of incision and the routine open cholecystectomy, the causes including severe pericholecyst adhesion in 7 cases, cholecystic artery bleeding in 1 case, iatrogenic injury, to common bile duet in 2 cases underwent T tube drainage thereafter, hepatic ductal injury in 1 case underwent Roux-en-Y hepaticojejunostomy thereafter, encountering of cholecystic carcinoma in 1 case underwent cholecystectomy and regional lymphatic clearance. Bile leakage occult in 5 cases and cured by 3 to 7 days external drainage. 2 cases underwent reoperation due to residual stones in cholecystic duct within 6 months follow-up. Conclusion Open eholeeysteetomy via mini-incision demonstrates the advantages of minimal invasion and rapid recovery, can be considered a safe and applicable operation.