电凝吸引器钝性分离法在重症急性胆囊炎早期腹腔镜胆囊切除术中的应用

Blunt Dissection by Using Electric Coagulation/Aspiration Dissector in Early Laparoscopic Cholecystectomy for Acute Severe Cholecystitis

目的探讨电凝吸引器钝性分离法在重症急性胆囊炎早期腹腔镜胆囊切除术中的应用价值。方法对2008年3月～2009年7月56例诊断为重症急性胆囊炎患者在四孔法腹腔镜下应用电凝吸引器钝性分离法处理胆囊三角及从胆囊床上分离胆囊,记录出血量、手术时间、中转开腹率,术后腹腔积液、脓肿,肺部并发症及合并心脑疾患、糖尿病并发症,出院后随访有无胆囊床积液及胆道狭窄等并发症。结果手术时间35～110(62.7±16.7)min,出血量40～200(80.2±40.5)ml。无中转开腹手术及胆道损伤、胆漏,无明显腹腔积液、脓肿,无严重肺部并发症,围手术期未发生脑梗死或脑出血,5例冠状动脉支架置入者无心绞痛、心肌梗死及心律失常。术后随访2～3个月,无发热、腹痛及黄疸,影像学检查无胆囊窝血肿、积液以及胆道狭窄等并发症。结论电凝吸引器钝性分离法治疗重症急性胆囊炎安全有效,值得临床推广。

Objective To evaluate the value of blunt dissection by using electric coagulation/aspiration dissector in laparoscopic cholecystectomy （LC） for the treatment of acute severe cholecystitis. Methods From March 2008 to July 2009,we performed LC on 56 patients with acute severe cholecystitis by using four trocars. During the operation,electric coagulation/aspiration dissector was employed to dissect the Calot＇s triangle and remove the gallbladder from the gallbladder bed. The intra-operative blood loss,operation time,rate of conversion to open surgery,and postoperative complications including seroperitoneum,abdominal abscess,pulmonary,cardiovascular and cerebraovascular affairs,diabetes mellitus related complications,hydrops in the gallbladder bed,and biliary stenosis. Results The operation was completed in 35 to 110 minutes [mean,（62.7±16.7） minutes],during the operation,the blood loss ranged from 40 to 200 ml [mean,（80.2±40.5） ml]. No patient was converted to open surgery,or developed biliary injury or leakage,seroperitoneum,abdominal abscess,or pulmonary complications. peri-operative incidence of cerebral infarction/hemorrhage was not detected. Five of the patients who had received coronary arterial stenting showed no angina,myocardial infarction or arrhythmia after the treatment. The patients were followed up for 2 to 3 months,during which no fever,abdominal pain,or jaundice was found,imaging examination revealed no hematoma/hydrops of the gallbladder bed nor biliary stricture. Conclusions Blunt dissection in LC by using electric coagulation/aspiration dissector is effective and safe for acute severe cholecystitis.