腹腔镜胆囊切除术治疗胆囊颈管嵌顿结石的手术技巧及治疗体会

The operation technique and treatment experience of laparoscopic cholecystectomy for incarcerated gallstones in the neck and duct of gallbladder

目的：总结腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）治疗胆囊颈管嵌顿结石的手术方法及体会。方法：回顾分析2004年8月至2009年8月为58例胆囊颈管嵌顿结石致急性胆囊炎患者施行LC的临床资料。全麻下行三孔法LC,充分游离胆囊三角,骨骼化胆囊动脉、胆囊管,暴露出胆囊管与胆总管汇合部,尝试将结石推入胆囊壶腹失败后,沿胆囊管长轴剪开0.5~1.0cm,取出结石,断端结扎或缝合。结果：53例（91.4%）成功完成LC,3例（5.2%）中转开腹,2例术后合并胆总管结石,行内镜逆行胰胆管造影取石后治愈。无胆管损伤、胆漏等手术并发症发生及死亡病例。术后住院2~9d,平均4d。56例术后随访半年无手术并发症发生。结论：正确解剖胆囊三角,必要时剪开胆囊管,完全可在腹腔镜下处理胆囊颈管嵌顿结石,并可避免胆管损伤。

Objective：To summarize the operative method and experience of laparoscopic cholecystectomy（LC） for incarcerated gallstones in the neck and duct of gallbladder.Methods：The retrospective analysis was made on the clinical data of 58 patients,who suffered from acute cholecystitis caused by incarcerated gallstones in the neck and duct of gallbladder and received 3-port LC under general anesthesia from Aug.2004 to Aug.2009.The Calot triangle was fully separated.The cystic artery and duct were skeletonized to expose the join of cystic duct and common bile duct.If the stone could not be pushed into the ampulla of gallbladder,the cystic duct was excised 0.5-1.0cm longitudinally,the stones were removed,and the broken end was ligated or sutured.Results：The LC was successfully completed in 53 cases（91.4%）,3 cases were converted to open surgery（5.2%）,2 cases complicated with common duct stones were cured by endoscopic retrograde cholangiopancreatography.No bile duct injury,bile leakage or death occurred in this series.The patients were discharged from hospital in 2-9 days（mean,4 days）.No complication was found during a 6-month follow-up in 56 cases.Conclusions：On the premise of correct anatomy of Calot triangle and cutting the cystic duct if necessary,incarcerated gallstones in the neck and duct of gallbladder can be treated by laparoscopy（using three Trocars） and the bile duct injury can be avoided.