腹腔镜胆囊切除术治疗急性坏疽性结石性胆囊炎

Clinical research of acute gangrenous calculous cholecystitis using laparoscopic cholecystectomy

目的探讨腹腔镜胆囊切除术治疗急性坏疽性结石性胆囊炎的手术适应证、手术技巧及并发症的防治。方法回顾分析2005年7月至2009年7月采取顺切、逆切或大部分切除等方法行腹腔镜胆囊切除术的500例急性坏疽性结石性胆囊炎患者的临床资料。结果合并胆囊胃瘘1例,同时行胃修补术;胆总管损伤4例,术中用5-0可吸收线行一期缝合,术后无胆漏、胆管狭窄发生。8例中转开腹。手术时间20～90min,平均35min;术中出血5～100ml,平均30ml。术中无肠管、血管损伤,术后无胆漏、出血发生,无其他严重并发症,全组无死亡病例。320例放置引流管,术后24～48h拔除。术后3～8d痊愈出院,平均住院时间5d。全组腹腔镜胆囊切除术成功率98.4%,中转开腹率1.6%。结论只要掌握恰当的适应证与手术时机,应用顺切、逆切或大部切除等方法,急性坏疽性结石性胆囊炎是可以安全成功施行腹腔镜胆囊切除术的。

Objective Discussing surgical techniques, indications and complications of acute gangrenous calculous cholecystitis using laparoscopic cholecystectomy. Methods Recalling and analyzing the clinical data of 500 cases of gallbladder surgery about the acute gangrenous calculous cholecystitis using laparoscopie eholecysteetomy with shun-cut operation, inverse operation cut and the most removal from July 2005 to July 2009. Results There were 500 cases using laparoscopic cholecystectomy ,one case was combined gallbladder gastric fistula with repair of gastric. Four cases of bile duct injury were closed by primary suture with 5-0 absorbable thread, there was no bile leakage, bile duct stricture. Eight cases were conversion to open surgery. Operation time was 20-90 min, average 35 rain. Amount of bleeding was 5-100 ml, average 30 ml. And there was no bile leakage, hemorrhage and other serious complications and no deaths. There were 320 cases using drainage tube and after 24-48 hours removing.It was fully recovered after 3-8 days, average 5 days without intestine and vascular damaged. All groups, the success rare of laparoscopic cholecystectomy was 98.4 %,the rate of conversion to open surgery was 1.6 %. Conclusions We can carry out laparoscopic eholecystectomy securely as long as we master appropriate indication and operation time with shun-cut operation, inverse operation cut and the most removal.