腹腔镜手术治疗胆囊颈部结石嵌顿患者45例体会

Clinical Analysis of Laparoscopic Cholecystectomy for Calculus Incarcerated Cholecystitis in 45 Cases

目的:探讨腹腔镜手术(LC)在治疗胆囊颈部结石嵌顿患者中的手术时机、手术方式和治疗效果。方法:回顾性分析我院2010年7月-2011年7月45例LC治疗急性胆囊炎发作伴胆囊颈部结石嵌顿患者的临床资料。27例予抗炎解痉治疗后早期(72h内)行LC治疗;4例经过抗炎解痉治疗症状好转出院后2周内再发,再度入院行急诊手术治疗;14例抗炎解痉治疗后出院1个月后来我院再行LC手术治疗。结果:45例手术均顺利进行,34例术后放置腹腔引流管,无中转开腹手术病例,未出现胆管损伤、胆瘘、出血等严重并发症,无手术死亡病例,术后患者恢复良好。结论:LC治疗急性胆囊炎伴胆囊颈部结石嵌顿手术治疗较无症状患者困难。我院治疗的14例1个月后来院行手术患者手术时间、术后放置引流管时间、住院时间均较其余31例手术患者时间短,术后恢复快。证明急性期胆囊炎伴胆囊颈部结石嵌顿患者予抗炎解痉治疗出院,等炎症消退后再行手术治疗是安全、可靠、可行的。

Objective：To discuss the surgical timing,procedure and efficacy of Laparoscopic surgery（LC）in the treatment of patients who got acute cholecystitis with gallbladder neck calculi incarcerated.Methods：A retrospective analysis was made of the clinical data of 45 cases of patients with acute cholecystitis with gallbladder neck calculi incarcerated in our hospital during July 2010 to July 2011.27 patients got initial intravenous fluids and broad spectrum antibiotics followed by laparoscopic cholecystectomy within 72 hours of presentation.4 patients＇s symptoms relapsed within two weeks after they were discharged and they got emergency surgery.14 patients got LC after one month.All of them got smooth operations with no severe complications.Results：45 cases were performed smoothly,34 cases placed the abdominal cavity drainage tube.No interim open surgery cases,did not appeared bile duct damage,bravery fistula,bleding and other serious complications.No deaths,postuperative patients recoverd well.Conclusion： LC for acute cholecystitis with gallbladder neck calculi incarcerated is much more difficult than asymptomatic patients.Compared with the early LCs,the late 14 LCs got shorter hospitalization,surgery time and drainage time.It＇s safe and feasible for patients to get surgical procedure（LC） after there clinical symptom relief.