腹腔镜胆囊切除术难点及处理要点

Difficulties in laparoscopic cholecystectomy and managements

目的:探讨腹腔镜胆囊切除术(Laparoscopic cholecystectomy,LC)术中操作难点其处理要点。方法:总结86例困难LC临床资料,其中胆囊炎急性发作,胆囊与周围组织粘连48例;胆囊慢性炎性反应反复发作,胆囊三角无解剖层次24例;萎缩性胆囊炎14例。结果:82例完成腹腔镜胆囊切除,4例中转开腹,中转原因为:急性胆囊炎,胆囊与周围组织粘连致密,无法显露胆囊1例;胆囊三角区出血,止血困难1例;胆囊三角区纤维化,解剖困难2例。结论:通过提高LC手术技巧,运用顺逆结合、紧贴胆囊壁解剖,彻底止血,必要时行胆囊大部切除等方法,提高LC手术成功率。

Objective To discuss the difficulties during laparoscopic cholccystcctomy （LC） and study the keys to deal with them. Method The clinical data of 86 cases of difficult LC performed from August 2008 to August 2011 were analyzed retrospectively,and the surgical operation approaches were summarized. The cases included 48 patients with compact conglutination around the gallbladder or gallbladder triangle area,24 patients with acute gallbladder inflammation,and 14 patients with atrophy of the gallbladder. Results The LC was completed in 82 eases ,and the other 4 cases were converted to open surgery. The cases who converted to open surgery included 3 pa- tients of poor exposure caused by the frozen - like adherence around the gallbladder, 1 case had bleeding at the gallbladder trian.- gle. Conclusion LC with difficult factors ,the experiences may be useful to such as execute LC in combination with antegrade and retrograde approaches for resection, dissect closely to the gallbladder wall, and when necessary, perform partial cholecystectomy.