纵剖牵引法切除复杂胆囊

REMOVAL OF COMPLICATED GALLBLADDER BY VERTICAL DISSECTION AND TRACTION METHOD

目的建立一种更安全可靠的手术方法用于开腹复杂胆囊切除。方法2007年5月—2008年4月,采用纵剖牵引法切除复杂胆囊6例。进腹后游离胆囊底,横行缝合2针后留作牵引,切开胆囊底,取石后直视下或借用手指触觉顺胆囊游离面分离。横缝牵引与纵行剖开交替进行,直至看到胆囊管螺旋瓣标志。切开胆囊管至近胆囊管根部。利用胆囊壁的牵引线作适度牵拉,辅以手指在胆囊黏膜的触觉指引,将胆囊从肝床切下。不解剖胆囊动脉。结果6例胆囊切除均顺利完成。术后恢复顺利,无严重并发症发生。结论纵剖牵引法能够提高复杂胆囊切除的安全性和准确性。

Objective To set up a safer approach in open cholecystectomy for complicated cases. Methods Vertical dissection and traction maneuver was used in six open cholecystectomies for complicated cases between May 2007 and April 2008. Having opened the peritoneum, two transverse sutures were done on the bottom of the gallbladder for traction, and the bottom was then cut open. The stones in the gallbladder were removed. The gallbladder was dissected along its surface under direct vision or with the help of the sense of fingers. Transverse suturing and traction and vertical cutting were performed alternatively until Lister patches were seen. The cystic duct was cut longitudinally through its base. The gallbladder was then removed from its bed on the hepatic surface without dissecting the cystic artery. Results A cholecystectomy was successfully done in all six cases, the postoperative course was uneventful. Conclusion Vertical dissection and traction can increase the safety and accuracy of complicated cholecystectomy.