胆囊颈部结石嵌顿26例术中处理体会

Gallbladder neck embeds of calculus ：a clinical analysis of 26 cases

目的 探讨胆囊结石颈部嵌顿手术方法的安全性及有效性。方法回顾性分析近4年来收治的26例胆囊颈部结石嵌顿的临床资料。结果在26例患者中，均有胆囊炎症重或Calot三角解剖不清，均行开腹手术。其中，6例由腹腔镜胆囊切除术中转开腹胆囊切除术内胆囊逆行切除，术中无肝外胆管、肠管、血管的损伤，术后患者均康复。结论胆囊颈部结石嵌顿采用打开胆囊、吸净胆汁，取出结石后行浆膜内胆囊逆行切除不失为一种安全的手术方法，在胆囊三角处，宜采用钝性分离，忌用暴力和电刀。

Objective To explore the effect and safety of the operationive treatment of calculus incarceration in neck of gallbladder. Methods We analyzed retrospectively the clinical data of 26 cases with calculus in carceration In neck of Gallbladder. Results All 26 cases patients were found to have serious cholecystitis and unclear anatomic site in Calot＇s trangle. Six patients＇operative way had to transform from laparoscopiccholecystectomy to cholecystectomy. Endogenous membrane of gallbladder were excised retrogradely in the operation. In operative process, there were no injury in extrahepatic bile duct, intestinal canal and vascular. The all patients were recovery and discharge after operation. Conclusion It is one kind of good choice to open the gallbladder, aspirate the bile and extract the stones. And then performing endogenous membrane retrograde cholecystectomy. For treatment of the Calot＇s trangle areas, blunt dissection may used. It is dangerous that using sharp dissection and electrosurgical knife.