萎缩性胆囊炎106例腹腔镜手术治疗

Laparoscopic Surgery for Atrophic Cholecystitis:Report of 106 Cases

目的总结腹腔镜下萎缩性胆囊炎手术治疗的技巧及经验。方法 2000年2月～2010年1月对106例萎缩性胆囊炎行三孔法腹腔镜胆囊切除术。结果腹腔镜胆囊切除88例,胆囊大部切除12例,6例行中转开腹胆囊切除(3例因Calot三角致密粘连、解剖不清,胆囊管无法分离,中转开腹胆囊切除;2例胆囊与周围组织致密粘连,分离后见十二指肠内瘘形成,修补;1例胆囊颈部结石压迫右肝管造成右肝管穿孔,行胆管整形T管引流术,T管12个月后拔除)。术后胆漏5例,保持腹腔引流通畅,术后7～10 d拔除引流管。106例随访3～24个月:1例中转开腹行胆管整形T管引流术,术后12个月T管造影显示胆管黏膜连续性正常,顺利拔除;4例出现轻度腹泻,术后3个月内症状逐渐消失;2例术后轻度腹胀,对症治疗后好转;均无胆管狭窄、肠梗阻等术后并发症。结论在细致操作及熟练的腹腔镜技术前提下,萎缩性胆囊炎腹腔镜手术是安全、可行的,但Calot三角冰冻样粘连、腹腔致密粘连或内瘘形成等复杂情况是中转开腹手术的指征。

Objective To summarize the techniques and our experience on laparoseopic cholecysteetomy（LC） for atrophic cholecystitis. Methods The clinical data of 106 patients with atrophic cholecystitis, who underwent three-port LC from February 2000 to January 2010, were retrospectively analyzed. Results In the 106 cases, total cholecystectomy was performed on 88 cases, subtotal cholecystectomy was carried out on 12 cases, the other 6 patients were converted to open surgery because of unclear anatomy of Calot＇ s triangle （3 cases）, internal duodenal fistula after separating the adhesion between the cholecyst and adjacent tissues （2 cases）, or perforation of the right hepatic duct due to cholecystolithiasis in the gallbladder neck （ 1 case, ＂T＂ tube drainage was made to reform the bile duct and was not removed until 12 months later）. After the LC, five patients developed biliary leakage and thus received drainage for 7 to 10 days. A follow-up for 3 -24 months was achieved in 106 patients; during the follow-up, one patient received an open surgery for bile duct plasty and T-tube drainage （ which was removed 12 months later when T-tube cholangiography showed normal intact mucosa） ; 4 patients showed mild diarrhea, which disappeared gradually in 3 months; 2 patients had mild abdominal distention, which was cured by symptomatic treatment. No bile duct stenosis, or intestinal obstruction occurred. Conclusions With the accumulation of experiences and improvement of technology, LC is feasible and safe for atrophic cholecystitis. Indications for conversion to open surgery include frozen Calot＇ s triangle, severe abdominal adhesion, and internal fistula formation.