胆囊颈管结石嵌顿患者行腹腔镜胆囊切除术的体会

Experience of laparoscopic cholecystectomy in neck and duct of gallbladder calculus

目的:探讨胆囊颈管结石嵌顿合并急、慢性胆囊炎的患者行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的特点及注意事项。方法:回顾分析78例胆囊颈管结石嵌顿伴急、慢性胆囊炎、胆囊积液患者行LC的临床资料。结果:76例顺利完成LC,其中3例为Mirizzi综合征Ⅰ型;1例因合并胆囊结肠漏、胆囊右肝管漏中转开腹,另1例为Mirizzi综合征Ⅱ型,术中胆总管损伤中转手术行胆总管对端吻合"T"管支撑引流术。结论:腹腔镜手术治疗胆囊颈管结石嵌顿患者(包括Mirizzi综合征Ⅰ型)是安全可行的,术中对解剖困难或合并胆囊与邻近脏器内瘘的形成以及Mirizzi综合征Ⅱ型以上等应及时采取开腹手术。

Objective ：To explore the characteristics and notices of laparoscopic cholecystectomy （LC） to patients with calculus in neck and duct of gallbladder combined with acute or chronic cholecystitis. Methods ： The clinical data of LC to 78 cases with calculus in neck and duct of gallbladder combined with acute chronic cholecystitis and hydrops of gallbladder were analysed retrospectively. Resuits ： Seventy-six cases were successfully performed LC, three cases were Mirizzi syndrome type Ⅰ , and one case was converted to open surgery because of gallbladder-colon fistula and gallbladder-right hepatic duct fistula, and one was converted to choledocholithotomy with T-tube drainage because of Mirizzi syndrome （ type Ⅱ ） combined with injury of common bile duct. Conclusions ： LC is suitable and safe for patients with calculus in neck and duct of gallbladder （ including Mirizzi syndrome, type Ⅰ ）. Open surgery should be advocated when there is difficulty in anatomy or fistula formation between gallbladder and organ nearby, or Mirizzi syndrome （ type Ⅱ or above） happens.