腹腔镜胆囊大部切除术在困难胆囊切除中的临床应用

Clinical application of laparoscopic subtotal cystectomy in difficult cases of surgical removal of gallbladder

目的探讨腹腔镜胆囊大部切除术的适应证、手术方法及临床价值。方法该组29例困难胆囊切除均行腹腔镜胆囊大部切除术,对胆囊管的处理:其中套扎法10例,缝扎法8例,封闭法11例。结果手术时间45～70min,术中出血30～100mL,术后引流管留置时间24～36h,术后住院时间3～7d,无中转开腹,无大出血、胆漏、胆道损伤等严重并发症。结论腹腔镜胆囊大部切除术是一种安全有效的手术方法,在临床工作中合理应用该方法可以降低腹腔镜胆囊切除术中转开腹和并发症的发生率。尤其是封闭法更简便、易行、安全、有效。

[Objective] To evaluate the indication, operative techniques and clinical utility of laparoscopic Subtotal cystectomy. [Methods] 29 cases of difficult surgical removal of gallbladder who received laparoscopic subtotal cystectomy were evaluated, with 10 cases ligated with cannule, 8 cases with suture, and 11 cases were occluded. [Results] Average operation time was 45～70 min; average hemorrhage in operation was 50 cc （30～100 co）; average drain depositing time after operation was 24～36 h; the average in hospital days was 3～7 d. There were no severe complications during the operation. [Conclusions] Laparoscopic subtotal cystectomy is a safe and effective therapy which reduces the incidence of complications and cellotomy during the operation, and in which the occlusion was of the best safety, efficiency, and operative simpleness.