腹腔镜下困难的胆囊切除术治疗体会

Experiences in high difficulty laparoscopic cholecystectomy

目的 探讨腹腔镜下困难的胆囊切除术的经验、手术操作技巧及临床效果。方法 回顾性分析2005年7月至2007年7月完成的397例腹腔镜胆囊切除术（LC）中复杂困难的胆囊切除术48例患者的临床资料。结果 48例腹腔镜下困难的胆囊切除术中，43例获得成功，5例中转开腹行胆囊切除术。术后2例切口感染，所有患者均痊愈出院。结论 根据术中实际情况和术者的经验，精确处理Calot三角，适时把握中转开腹手术的时机，腹腔镜下困难的胆囊切除术仍是安全可行的。

Objective To study the skills of laparoscopy for hight difficulty cholecystectomy. Method Forty-eight cases of hight difficulty laparoscopic cholecystectomy from July 2005 to July 2007 were analyzed retrospectively. Result In 48 cases, 5 cases were converted to open surgery, 2 cases suffered incision infection, all the patients recovered. Conclusion According to the operating status and experience of the performer, Calot triangle dissection and judge good opportunity to change open surgery are the key factors to the successful operation for difficult and complex laparoscopic cholecystectomy, which is safe and feasible.