腹腔镜胆囊切除术治疗胆囊颈部结石嵌顿并急性化脓性胆囊炎528例临床分析

CLINICAL ANALYSIS ON 528 CASES BY LAPAROSCOPIC CHOLECYSTECTOMY FOR STONE INCARCERATED IN COLLUM VESICAE BILIARIS AND ACUTE PYOGENIC CHOLECYSTITIS

目的探讨腹腔镜胆囊切除术治疗胆囊颈部结石嵌顿并急性化脓性胆囊炎的可行性、安全性和手术时机。方法回顾性分析我院528例施行腹腔镜胆囊切除术治疗胆囊颈部结石嵌顿并急性化脓性胆囊炎的病历资料。结果524例手术顺利完成,4例因出血或胆道损伤而中转开腹。发病72小时以内手术396例,72小时以上手术132例,后者发生胆道损伤2例,中转修补胆道后治愈,发生胆汁渗漏2例,经引流后治愈。术后第1天因急性心肌梗塞死亡1例,其余患者均痊愈出院。结论只要掌握必要的手术技巧,LC治疗胆囊颈部结石嵌顿并急性化脓性胆囊炎是安全、可行的,把握好手术时机非常关键,发病72小时以内手术效果较好。

Objective To evaluate the feasibility, safety and operation opportunity of laparoscopic cholecystectomy for the treatment of stone incarcerated in collum vesicae biliaris and acute pyogenic choleeystitis. Methods Laparoscopic cholecystectomy was performed for 528 eases in our hospital for the treatment of stone incarcerated in collum vesicae biliaris and acute pyogenic cholecystitis were reviewed. Results Laparoscopic cholecysteetomy was succeeded in 524 cases. 4 cases were changed to take laparotomy because of hemorrhage or injury of biliary tract. 396 cases were operated with 72 hours, and 132 eases were operated after 72 hours of invasion. 2 biliary tract injury eases were cured after the biliary tract repair operation. 2 bile seepage eases were cured after draining. 1 ease died of acute myocardial infarction in the first day after the operation and other patients all recovery. Conclusion Laparoscopic cholecystee- tomy is relatively safe and feasible for the stone incarcerated in eollum vesicae biliaris and acute pyogenie eholecystitis. It is very important to grasp the opportunity of operation. It is more effectively that the operation is performed with in 72 hours of the invasion.