有腹部手术史的腹腔镜胆囊切除术

Laparoscopic cholecystectomy after operation on abdominal region

目的总结有腹部手术史的腹腔镜胆囊切除术(LC)的临床经验。方法对286例有腹部手术史的腹腔镜胆囊切除术的临床资料进行分析。结果248例顺利完成腹腔镜手术,38例中转开腹手术。其中因建立气腹困难17例、胆囊Calot三角区解剖不清12例、手术副损伤9例。全部病例均临床治愈。结论有腹部手术史的LC难度较大,有一定风险。但是,正确选择穿刺孔,建立有效的气腹空间,掌握娴熟的腹腔镜操作技术和丰富的胆管手术经验,注意防范手术各环节可能造成的副损伤,顺利完成腹腔镜手术是安全、可行的。手术效果明显优于开腹手术。

[ Objective ] To summarize the clinical experience on laparoscopic choleeystectomy after operation in abdominal region. [Methods] The clinical data of 286 cases undergoing after operation in abdominal region were retrospectively analyzed. [ Results ] Laparoseopic cholecystectomy was successfully accomplished in 248 cases. The remaining 38 cases were converted to open operation. Among these unsuccessful cases, 17 cases had difficulty in pneumoperitoneum, 12 cases had unclear anatomy of eholecyst triangle, and 9 cases had affiliated injury. However, all the 38 cases were cured afterwards. [Conclusion] There is some difficulty and risk in taparoscopic cholecystectomy after operation in abdominal region. However, some methods can be used to make sure the success of operation, such as the correctly selecting puncture spine sheath, using skillful experience on taparoscopic eholecystectomy, and being aware of possible affiliated injury in the operation. Compared with the classical open choleeysteetomy, laparoscopic cholecystectomy after operation in abdominal regions is a safe, reliable and effective technique.