腹腔镜胆囊切除术治疗胆囊颈部结石嵌顿伴胆囊积液的临床研究

Clinical research of laparoscopic cholecystectomy for incarcerated cystic duct stones accompanying gallbladder empyema

目的探讨胆囊颈部结石嵌顿伴胆囊积液患者行腹腔镜胆囊切除术的可行性、安全性和手术经验。方法回顾性分析18例胆囊颈部结石嵌顿伴胆囊积液患者行腹腔镜手术的临床资料,并与行开腹胆管探查T管引流术治疗的45例患者进行对比。结果观察组17例顺利完成腹腔镜手术,有1例中转开腹1例,中转率5.56%,手术成功率为94.4%,对照组手术成功率为91.1%,两组手术成功率比较差异无显著性(P>0.05)。治疗组术后并发症发生率显著低于对照组(P<0.05)。治疗组术后胃肠道功能恢复时间和平均住院时间与对照组比较显著缩短,相比较差异有显著性(P<0.05);随访期内两组均未发现胆漏、胆管狭窄、残留结石、胆道感染及胆管狭窄病例,无死亡病例。结论腹腔镜胆囊切除术治疗胆囊颈部结石嵌顿伴胆囊积液是安全可行的,必要时中转开腹,不可强求。

【Objective】To explore the feasibility and surgical techniques of laparoscopic cholecystectomy （LC） in the treatment of incarcerated cystic duct stones associated with gallbladder empyema.【Methods】Clinical data of 35 cases of laparoscopic cholecystectomy for incarcerated cystic duct stones associated with gallbladder empyema were analyzed retrospectively,compared with 45 cases treated using open T-tube drainage of bile duct exploration. 【Results】17 cases were successfully treated with LC and one case was convened to open procedure（5.56%）. The success rate of surgery of the treatment group was 94.4%,the success rate of surgery of control group was 91.1%,the difference between two groups was no significant （P 0.05）; the incidence rate of complications of the treatment group was 8.9%,it was lower than the control group （20.0%）,the difference between two groups was significant （P 0.05）; the recovery time of gastrointestinal function and hospital stay of treatment group were shorter than the control group,the difference between two groups was significant （P 0.05）; there were no bile leakage,bile duct stricture,residual stones,biliary tract infection and bile duct stenosis cases and no deaths in the two groups.【Conclusion】LC to cure neck cholecystolithiasis of gallbladder and gallbladder empyema is reliable and effective and could be open abdomen if necessary.