难切性胆囊的腹腔镜治疗

LAPAROSCOPIC CHOLECYSTECTOMY TO CURE NECK CHOLECYSTOLITHIASIS OF GALLBLADDER AND GALLBLADDER EMPYEMA

目的探讨胆囊壶腹结石嵌顿伴胆囊积脓的腹腔镜胆囊切除(LC)的可行性及手术方法。方法76例急性胆囊炎伴胆囊壶腹结石嵌顿胆囊积脓患者行LC。手术中见胆囊管增粗34例,阶梯施夹法11例,大号钛夹法9例,套扎线法4例,HOO-M-LOK结扎11例;手术中取出胆囊管结石9例,处理胆囊床出血6例;6例行胆囊前壁切除手术。结果76例中LC全部成功,手术后均放置引流,手术后2例出现胆漏,经放置的腹腔引流管治愈,全组病例无术后出血,内脏损伤和胆道损伤等并发症发生。结论急性胆囊炎伴胆囊壶腹结石嵌顿和胆囊积脓患者LC手术可行,可达到LC的良好效果,不是LC手术的禁忌症。

Objective To explore the effect and operation method of neck cholecystolithiasis of gallbladder and gallbladder empyema. Methods The clinical data of 76 patients with neck cholecystolithiasis of gallbladder and ballbladder empyema treated in our hospital from 1999 to 2004 were retrospectively analyzed. The 34 patients of those patients＇cystic duct were increased, 11 cases of those were treated by ladder forceps holder,9 cases of those were treated by big type titanium clamp,4 cases of those were treated by ligation, 11 cases were treated by HOO-M-LOK;9 cases were got calculus from cystic duct; 6 cases of those were treated successfully of gallbladder bed hemorrhagic ;6 cases of those were treated by greater part cholecystectomy. Result All the 76 patients were successfully accepted laparoscopic cholecystectomy,all patients were placed drainage tube ,2 cases were cholorrhagia ,they were cured by drainage tube. All patients were not complicated of hemorrhage, viscera trauma and trauma of biliary tract. Conclusion Laparoscopic cholecystectomy to cure neck cholecystolithiasis of gallbladder and gallbladder empyema is good effect ,it is not contraindication of laparoscopic cholecystectomy.