超声刀在腹腔镜胆囊切除术中的应用(附485例报告)

Application of Ultrasonic Harmonic Scalpel in Laparoscopic Cholecystectomy:Report of 485 Cases

【目的】总结超声刀在腹腔镜胆囊切除术中的应用方法、技巧、注意事项、及实现去钛夹化优越性的体会。【方法】基本同常规LC方法,丝线结扎胆囊管后切断之,胆囊动脉及胆囊床组织用超声刀分离、剥离、凝固、切割止血。【结果】本组485例均痊愈出院,其中中转开腹11例。体内保留钛夹79例,胆囊破裂45例,放置腹腔引流管54例。【结论】在LC手术中超声刀的应用,具有以下优越性:①止血效果好;②切割精确;③安全性高;④手术时间短;⑤基本实现去钛夹化优点。但是,若使用不当,仍能引起严重的副损伤及并发症。

[Objective]To summarize the experiences and superiority of ultrasonic harmonic scalpel in laparoscopic cholecystectomy（LC）. [Methods] The method was same as conventional LC. Ductus cysticus was cut off after it was tied up with a silk thread. And then arteria cysticus and bed cysticus were separated, stripped, coagulated and cut off by ultrasonic harmonic scalpel. [Results] Four hundred and eighty five patients have been cured, of whom 11 patients were converted to open surgery, and there were 79 cases who have the Ti clips in body. Gallbladder was split in 45 cases. Drainage tubes were put into abdominal cavities of 48 patients. [Conclusion] The application of ultrasonic harmonic scalpel in laparoscopic cholecystectomy has the following advantages such as good-to-excellent effects on stopping bleeding, accurate cut, safe to the patients, short operative time, and needing not to use Ti clips in more patients. But it is unlikely to avoid duct damage and other complications completely.