腹腔镜治疗复杂胆囊疾病16例

Applicative experience of laparoscopic complicated cholecystectomy

目的：探讨复杂胆囊疾病腹腔镜胆囊切除术的处理办法。方法：分析总结16例急性胆囊炎、慢性萎缩性胆囊炎等行腹腔镜胆囊切除术的方法、经验。结果：15例手术顺利,无术后出血、胆漏及肝外胆管损伤,平均手术时间90 min（60～120 min）,术后恢复顺利,无严重并发症;1例因Mirizzi症行开腹胆囊切除术。术后平均住院时间4 d（2～6 d）,随访时间3～12个月,无症状复发,效果满意。结论：对急性胆囊炎、慢性萎缩性胆囊炎等患者行腹腔镜胆囊切除术安全可行,不但能够达到胆囊切除的目的,而且能避免肝外胆管和血管损伤,但必须严格掌握适应证,正确处理胆囊残余部分。

Objective To explore measures for handling acute cholecystitis （ACC） or atrophic cholecystitis （ATC） in laparoscopic cholecystectomy （LC）. Method Sixteen cases of ACC or ATC in LC were analyzedretrospectively. Results LC was performed smoothly in 15 patients without severe complications such as postoperative hemorrhage, bile leakage and extra-hepatic bile duct injury. One case needed conventional surgery because of Mirizzi syndrome. The mean operative time was 90 min （60 - 120 min）, and the mean postoperative hospitalization was 4 d （2 -6 d）. No long-term complication took place in 3 - 12 months＇ follow-up. Conclusion It is a safe and feasible method to treat ACC or ATC in LC. In order to decrease the injury rate of extra-hepatic bile duct and blood vessel,attentions should be paid to the indication of LC and management of the residue of cystic duct.