两孔法腹腔镜胆囊切除术54例

The double-incision laparoscopic cholecystectomy plus report of 54 cases

目的总结两孔法腹腔镜胆囊切除术的经验及技巧。方法2006年3月-2007年6月采用两孔法行腹腔镜胆囊切除术54例。采用在胆囊体部、胆囊壶腹部缝合丝线并经腹壁引出体外,牵拉丝线,暴露胆囊三管关系、胆囊与胆囊床的关系,替代胆囊抓钳,顺利完成手术。结果本组54例成功施行两孔法LC 53例,成功率98.1%。1例胆囊充满型结石,术中胆囊动脉出血,暴露欠佳,增加右肋缘下戳孔,成功止血,完成手术。总住院时间4 d￣8 d,平均6 d。无胆瘘、胆管狭窄、腹腔活动性出血等并发症出现。53例随访1年￣2年,平均11个月,无胆管结石复发及其他并发症出现。结论两孔法LC,手术成功率高,风险低,减少了戳孔,腹壁切口美观,完全达到了常规LC的效果,在熟练掌握常规LC的基础上,选择合适的病例,可推广应用。

Objective To summarize the techniques and experiences of the double-incision laparoscopic cholecystectomy. Methods From March 2006 to June 2007, 54 patients had been treated by double-incision laparoscopic cholecystectomy. The procedure performed by sewing in the body and the neck of the gallbladder as a substitution of gripping tongs to show the spacial-relationship of the hepatic duct, the bile duct and the cystic duct, and the relationship between the gallbladder and the gallbladder bed.Results In this study 54 patients was involved.The operation was successful in 53 patients and one was failed and due to the gallbladder full of gallstones and bleeding of the cystic artery. It was completed by hemostasis through another incision below the edge of the right costal margin. The length of stay ranged from 4 days to 8 days, the average was 6 days. No complication happened such as bile leak, bile duct narrow and active celiac bleeding. The follow-up time of the 53 patients range from 1 year to 2 years,the average wasl 1 monthes. No complication was found. Conclusion With the same effects as conventional LC, high success rate, low risk and less scar, double-incision LC can be used generally on the condition of skillful in conventional LC and selecting qualified cases.