胆囊后三角解剖入路在急性胆囊炎腹腔镜下胆囊切除术的应用

Applied anatomy of posterior Calot's triangle and its clinical significance in laparoscopic cholecystectomy

目的讨论胆囊后三角解剖入路在急性胆囊炎腹腔镜下胆囊切除术(laparoscopiccholecys-tectomy,LC)的应用。方法回顾性分析笔者2004年8月～2010年10月收治的217例急性胆囊炎患者全麻下行三孔法LC的临床资料。结果 93.1%(202例)成功完成LC,4.6%(10例)中转开腹,5例术后合并胆总管结石,行ERCP取石后治愈。无胆管损伤、胆漏、出血等手术并发症。术后根据手术操作情况决定是否放置引流。术后住院2～12d,平均4.5d。193例术后随访半年无手术并发症。结论在急性胆囊炎的病例中采用后三角入路三孔法LC安全可行、手术成功率较高、容易掌握,可减少手术并发症,尤其适用于胆囊三角严重粘连患者,值得提倡与推广。

Objective To explore anatomic features of posterior Calot＇s triangle and its clinical significance in laparoscopic cholecystectomy （LC）. Methods The clinical data of 217 patients with acute cholecystitis underwent LC by using three trocars in our hospital from Aug. 2004 to Oct. 2010 were retrospectively analyzed. Results Of the patients, LC was successfully completed in 202 cases （93.2%）, however, 10 cases （4.6%） were converted to open surgery, 5 cases complicated with common duct stones were cured by ERCP. No biliary injury,bile leak or hemorrhage occurred in this series. Postoperative surgical drainage was performed according to the operating conditions. The patients were discharged from hospital in 2-12 days （averagely 4.5 days）. No complication was found during a 6-month follow-up in 193 cases. Conclusions It is safe and feasible to perform LC by using three trocars for treating acute cholecystitis, especially for those with severe tissue adhesion in posterior Calot＇s triangle.