无钛夹腹腔镜胆囊切除术在基层医院的应用

Application of non-titanium clip laparoscopic cholecystectomy in basic hospital

目的：探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）术中应用无钛夹丝线结扎法的可行性、适应证和临床价值。方法：回顾分析应用腔内丝线结扎技术为60例患者行LC的临床资料。结果：8例行四孔法LC,余均行三孔法LC,无中转开腹。手术时间30~90min,平均50min,术后住院2~6d,均痊愈出院,未发生胆管损伤、胆漏、出血及胆管结石等并发症。5例Winslow孔放置多孔乳胶引流管,引出淡血性渗出液10~100ml/d,术后1~3d拔除。结论：无钛夹丝线结扎法用于LC具有结扎可靠、术后患者疼痛轻、创伤小、康复快、经济等优点,并可避免因钛夹残留、移位和游走所致的并发症。只要选择病例合适,精心训练,在基层医院开展结扎法LC是安全、有效、可行的。

Objective：To explore the feasibility,indications and clinical value of silk suture ligation without titanium clip in laparoscopic cholecystectomy（LC）.Methods：Retrospective analysis was made on clinical data of 60 patients using intracavity silk suture ligation technique in LC.Results：Three-port method was used in 52 cases and four-port method was used in 8 cases to complete the operation without conversion to open surgery.The mean operation time was 50min（30-90） and postoperative hospital stay was 2-6d.All patients were recovered and discharged without complications of bile duct injury,bile leakage,bleeding or biliary stones.10-100ml/d bloody exudate was drained for each patient after placing porous latex drainage tube near the Winslow hole in 5 cases and the tubes were removed in 1-3d.Conclusions：Silk suture ligation without titanium clip in LC has the advantages of reliability,less postoperative pain,less injury,quicker recovery,economy,no residual titanium and avoiding complications caused by displacement and migration of titanium clip.Silk suture ligation in LC is safe,effective and feasible if appropriate cases are chosen after the doctors are trained strictly in primary hospital.