腹腔镜胆囊切除术116例分析

A REPORT ON 116 CASES OF LAPAROSCOPIC CHOLECYSTECTOMY

目的：总结１１６例腹腔镜胆囊切除术的手术经验。方法：使用日本Ｏｌｙｍｐｕｓ公司生产的全套腹腔镜手术设备，采用小开腹气腹法、穿刺气腹法及悬吊法等３种手术方式。结果：除１例患者于术后６９ｄ因糖尿病并发症死亡外，余均恢复良好。出现手术并发症８例（６９％），其中严重并发症５例，为肝右动脉损伤１例、肝总管损伤１例、十二指肠损伤１例、腹腔感染２例。１３例中转开腹手术。总平均手术时间为８０ｍｉｎ，平均失血量５５ｍｌ，无输血病例。结论：选择合适的适应证，术前通过Ｂ超等检查对手术难度进行评估，术中熟练配合和恰当处理以及良好的仪器、器械功能状态是提高腹腔镜胆囊切除手术效果的关键因素。

Objective:To improve the effect of laparoscopic cholecystectomy.MethodsResults of 116 cases of laparoscopic cholecystectomy were analyzed.The set of laparoscopic instrument were made by Olympus Company.The operations were done by three methods:small open pneumoperitoneum,puncture pneumoperitoneum,and gasless.Results:In all the groups,only one patient died of diabetic complication on the 69th day after operation.The morbidity rate was 6 9%,among them serious complications were occured in 5 cases:one with right hepatic artery injury,one bile duct injury,one duodenal injury,and two infections of abdominal cavity.Thirteen cases were converted to open surgery.The average operating time was 80 minutes(30 to 270 minutes)and average blood loss was 55 ml.No transfusions were needed in all the groups.Conclusion:The key of success of improving the effect of laparoscopic cholecystectomy was the choice of the indication,assessment of difficulty by B type ultrasound before operation,skilled cooperation and appropciate management during operation and good instrumentation.