腹腔镜下胆囊三角解剖困难的处理

Strategy of Difficult Dissection on the Calot's Triangle under Laparoscopic Cholecystectomy

目的 总结腹腔镜下对胆囊三角解剖困难情况的处理方法及体会。方法 回顾性分析2001年3月至2006年1月我院行腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）术中遇到的胆囊三角解剖困难68例，其中胆囊三角严重粘连者29例，胆囊管结石嵌顿17例，胆囊管过短（≤1cm）6例，胆囊动脉变异16例。根据情况分别采取逆行切除胆囊、胆囊切开取石、胆囊大部分切除、中转开腹术。结果 全组中61例完成LC，中转开腹7例。26例置腹腔引流管，1-5d后拔管。胆总管轻微刺伤2例，采用无损伤线缝合；伤口感染3例，经换药后治愈；膈下积液6例，经B超引导穿刺抽液（2例）和延长抗感染治疗（4例）痊愈。无胆漏、大出血等严重并发症。结论 根据胆囊三角解剖困难的具体情况作相应处理，有利于提高LC的成功率，减少LC并发症。但解剖极困难时，需果断中转开腹。

Objective To review the strategy of difficult dissection on the Calot＇s triangle under laparoscopic cholecystectomy （ LC ）. Method 68 cases of LC posing difficult dissection on Calot＇s triangle were reviewed, including severe adhesion in 29 cases, cystic ductal stone incarceration in 17 cases, short cystic duct in 6 cases, cystic artery variation in 16 cases. A variety of procedure conducted based upon each case＇s situation, as cholecystectomy in retrograde fashion, removal of the incarcerated stone through cystic duct incision, subtotal cholecystecomy and conversion to open surgery. Result 7 cases conversed to open surgery. Drain- age applied in 26 cases. Minor injury of common bile duct occurred in 2 cases and repaired by fine suture, 3 cases experienced wound infection, 6 cases developed subphrenic fluid collection who subsequently underwent paracentesis drainage and prolonged anti-infection medication. No severe complications such as bile leakage and massive haemorrhage occurred. Conclusion Strategy to difficult dissection on the Calot＇s triangle is individualized treating on the basis of each circumstance.