胆囊结石并发急性胆囊炎腹腔镜胆囊切除探讨

Laparoscopic Cholecystectomy(LC) in Patients with Acute Cholecystis Complicated by Symptomatic Gallstone

目的:探讨胆囊结石并发急性胆囊炎腹腔镜胆囊切除术的可行性。方法:对134例胆囊结石并发急性胆囊炎行腹腔镜胆囊切除术进行回顾性分析,依胆囊大小及壁厚程度进行分组,对手术时间、出血量、住院时间、腹腔引流、手术并发症进行分析。结果:平均手术时间:Ⅰ组(B超壁厚<5mm,胆囊>100mm)45min,Ⅱ组(壁厚>5mm,胆囊<100mm)80min;出血量:Ⅰ组平均40ml,Ⅱ组平均80ml;腹腔引流:Ⅰ组7例平均引流量40ml,Ⅱ组16例平均引流量65ml;平均住院时间Ⅰ组3.5天,Ⅱ组4.5天;Ⅰ组迟发性总胆管电凝伤1例,无中转,Ⅱ组中转5例。结论:准确掌握胆囊结石并发急性腹囊炎腹腔镜胆囊切除术的适应证,手术是安全可行的。

Objective：To discuss the evaluation of difficulties and complications in the operation for laparoecopic eholecystectomy（LC） in patients with acute cholecystis complicated by symptomatic gallstone. Methods; There were 134 cases of acute cholecystis complicated by symptomatic gallstone for which cholecystectomy was conducted during the recent 3 years. By ultrasound check, we divide the cases into 2 groups, Group 1： C, all bladder breastwork 〈 5mm, Gall bladder size 2〉 100mm. The two groups were compared in operating time, operative hemorrhage, drainage, complication, and hopital stay. Results：The average operation time of Group 1 is 45 min and 85 min in Group 2 respectively. The operative bleeding for Group 1 is 40ml; less than 80ml for Group 2, and hospital stay 3.5 days, shorter than 4.5 days for Group 2. Seven cases had draingae in Group 1 with the average drainaging amount of 40ml compared with 65ml in 16 cases of Group 2. One case of Group 1 has bile duct injury, and no case was converted in Group 1 compared with 5 in Group 2. Conclusions： With grasping strictly the operative indication and using the right operative method to the acute cholecystis patients with gallstone, LC is a safe choice of treatment for symptomatic gallstone.