复杂性胆囊结石腹腔镜治疗体会

Experience on Laparoscopic Cholecystectomy for Complicated Cholecystolithiasis:with A Report of 75 Cases

目的总结复杂性胆囊结石的腹腔镜手术治疗体会,探讨其安全性和可行性。方法对2009年5月～2012年5月行腹腔镜胆囊切除术的75例复杂性胆囊结石患者的临床资料进行回顾性分析。其中,急性胆囊炎48例,坏疽性胆囊炎12例,萎缩性胆囊炎5例,合并肝硬化5例,胆囊十二指肠瘘1例,Mirizzi综合征1例,合并腹部手术史3例。结果本组手术时间52～180 min,平均(67.5±35.5)min;术中出血量50～140 ml,平均(75.3±55.5)ml;术后住院时间5～30 d,平均(6.5±2.0)d。完成腹腔镜手术73例,其中腹腔镜下顺行胆囊切除术67例,顺逆结合胆囊切除4例,胆囊大部分切除2例。中转开腹2例,1例为胆总管损伤,行开腹胆囊切除加胆总管T管引流,另1例为右肝管和胆囊管并行过长解剖不清同时合并术中出血;术后并发急性脑梗塞1例。无术后大出血、胆瘘、腹腔脓肿、肠梗阻等并发症发生。结论充分的术前准备,术中仔细操作,及时中转开腹,以及认真细致地术后处理,腹腔镜治疗复杂性胆囊结石是安全可行的。

Objective To summarize the experience of laparoscopic cholecystectomy for complicated gallstone and to discuss its safety and feasibility. Methods The clinical data of 75 cases of complicated gallstone admitted from May 2009 to May 2012 were retrospectively analyzed. All patients were performed laparoscopic cholecystectomy. Results The average operation time was 67.5 ± 35.5 minutes （ranged from 52 to 180 minutes）, the average blood loss was 75.3 ± 55.5 ml（ ranged from 50 to 140ml）, and the average postoperative hospitalization was 6.5 ± 2.0 days （ranged from 5 to 30 days）. A total of 73 cases accomplished the laparoscopic cholecystectomy, including anterograde gallbladder resection in 67 cases, anterograde and retrograde gallbladder resection in 4 cases and greater partial cholecystectomy in 2 cases. Another 2 cases were conversed to open surgery because of biliary duct injury in one case and messy anatomy between right he- patic duct and cystic duct in another case. One case was found cerebrovascular accident after operation. No complications such as postoperative hemorrhea, biliary fistula, peritoneal abscess and intestinal obstruction occurred. Conclusion Laparoscopic cholecystectomy is safe, feasible and effective in the treatment of the complicated cholecystolithiasis based on the managements of sufficient preoperative preparation, careful intraoperative operating, timely conversion to laparotomy and conscientious postoperative managements.