困难型腹腔镜胆囊切除术的治疗经验

Experiences in difficult laparoscopic cholecystectomy

目的探讨腹腔镜胆囊切除术中遇到各种困难的处理。方法回顾分析1782例腹腔镜胆囊切除术中120例困难型的治疗经验。分析困难的原因,探讨、总结处理方法。结果困难型腹腔镜胆囊切除术主要由胆囊及其周围组织的病理改变引起术区粘连及解剖结构紊乱、解剖变异所致。本组115例完成了腹腔镜胆囊切除术,5例中转开腹行胆囊切除。术后并发胆瘘2例、肠麻痹2例,无术中、术后死亡。结论腹腔镜下胆囊切除遇困难时,必须熟悉相应的处理原则。只要充分暴露、细致解剖、认真止血,妥当引流,大多数困难型腹腔镜胆囊手术是能够安全完成的。

Objective To explore the experience of difficulties encountered in laparoscopic cholecystectomy processing.Methods The clinical data of 1782 cases of laparoscopic cholecystectomy,of which 120 cases were difficult type,were retrospective analyzed.Results Difficulties in laparoscopic cholecystectomy were mainly caused by the gallbladder and its pathological changes in the surrounding tissue adhesions caused by surgery and the anatomical structure of disorder.115 cases in this group completed the laparoscopic cholecystectomy,five cases were converted to laparotomy cholecystectomy.Postoperative biliary fistula were found in 2 cases,intestinal paralysis in 2 cases,and no postoperative death.Conclusion Fully exposion,detailed anatomiy,seriously proper drainage are the key points for safely performing difficult laparoscopic cholecystectomy.