腹腔镜胆囊切除术中Calot三角区域生理性解剖结构异常的辨识及手术技巧

The identification and operative skills of laparoscopic cholecystectomy in patients with physiological anatomical anomalies of Calot's triangle

目的总结腹腔镜胆囊切除术(LC)中Calot三角区域生理性解剖结构异常的辨识及手术技巧。方法回顾性分析37例Calot三角区域生理性解剖结构异常的腹腔镜胆囊切除术患者的临床资料,分析不同胆囊三角区解剖异常类型及相应的手术处理方式。结果37例患者全部完成LC。其中Mirizzi综合征1例,LC前先经内镜下逆行性胰胆管造影术(ERCP)证实后即行内镜下鼻胆管引流(ENBD);合并胆总管结石5例,LC前行内镜下乳头肌切开(EST)取石术+ENBD。所有患者均无并发症。结论胆囊三角区解剖结构异常增加了LC操作难度和潜在风险。严格遵循LC的相关处理原则,精确地解剖和正确辨认结构,灵活地运用多种解剖分离技巧及诊疗策略,可顺利完成LC。

Objective To summarize the identification and operative skills of laparoscopic cholecystectomy（LC） in patients with physiological anatomical anomalies of Calot＇s triangle,and to improve the success rate and prevent complications Method The clinical data of 37 cases who had physiological anatomical anomalies of Calot＇s triangle undergoing LC were collected and analyzed retrospectively.The relevant operative methods in different pathological anatomical anomalies in Calot＇s triangle were analyzed.Results Thirty-seven cases received LC.Before being conducted LC,1 case of Mirizzi syndrome received ENBD right after confirming by ERCP.Five cases who also had choledocholith and EST＋ENBD were performed before LC.None of them had complications.Conclusions The physiological anatomical anomalies in Calot＇s triangle increase the difficulty and potential risk of LC.Strictly adhere to the treating principle of LC,dissecting precisely,identifying related structures correctly and applying multiple dissection skills and treatment strategies flexibly are important factors to ensure a successful LC.