急性坏疽性胆囊炎腹腔镜治疗体会(附20例报告)

Experience in treating acute gangrenous cholecystitis with laparoscope (A report of 20 cases)

目的探讨腹腔镜治疗急性坏疽性胆囊炎的手术技巧性。方法回顾性分析我院自2006年4月至2007年7月LC治疗急性坏疽性胆囊炎20例临床资料。结果本组无一例中转开腹手术,1例由于胆囊壁已大部分坏疽、无法完整切除胆囊故行胆囊大部分切除,胆囊床电凝烧灼,术后无并发症发生,术后住院时间(除胆总管结石病例)3～5d。结论在急性坏疽性胆囊炎行腹腔镜胆囊切除时,联合使用超声刀、吸引器等方法,可减少出血,保持解剖清晰,提高安全、降低中转开腹率,值得进一步推广和应用。

Objective To investigate the operative skill in the treatment of acute gangrenous cholecystitis with laparoscope. Methods From April 2004 to July 2007, the clinical data of 20 cases with acute gangrenous cholecystitis received laparoscopic cholecystectomy （LC） were analyzed retrospectively. Results No one case was tranferred to open abdominal operation. Only one case underwent subtotal cholecystectomy because of serious gangrenous cholecystic wall. All patients had no severe complications, such as bile duct injury, intra-abdominal abscess, biliary leakage ,g astrointestinal injuries and wound infection. The postoperative hospitalzation was 3 to 5 days except for the case of holedocholithiasis. Conclusion When acute gangrenous cholecysititis undergoes laparoscopic cholecystectomy, combimed with ultrasound knife and aspirator would contribute to reduce intraoperative bleeding, keep anatomical clearance of operative field, improve operative safety and it can decrease the rate of open abdominal operation.