贴壶腹钝性分离法在冰冻Calot三角腹腔镜胆囊切除术中的应用

The application of blunt separation sticking to the ampullae in laparoscopic cholecystectomy with frozen Calot triangle

目的:探讨贴壶腹钝性分离法在冰冻Calot三角腹腔镜胆囊切除术(laparoscopic choelcystectomy,LC)中的应用价值。方法:回顾分析2006年4月至2012年4月应用贴壶腹钝性分离法为136例冰冻Calot三角患者行LC的临床资料。结果:126例成功完成LC,手术时间40～95 min,平均52.1 min;术后腹腔引流管引流出淡红色或淡黄色渗液,引流量30～120 ml/d,平均62 ml/d;引流管拔除时间1～4 d,平均2 d;术后下床活动、进食时间与普通LC相同,均为术后第1天;术后住院4～7 d,平均5 d;全组未发生肝外胆管损伤及手术死亡,3例(2.20%)术后轻微胆漏经保守处理治愈。2例(1.47%)意外胆囊癌、3例(2.20%)术后胆囊管残留结石患者再次行开腹手术;5例(3.68%)因结石嵌顿剥破胆囊管而中转开腹。结论:LC术中遇Calot三角解剖不清(冰冻Calot三角)时应用贴壶腹钝性分离法可预防胆管损伤、减少中转开腹,扩大了LC的手术适应证,值得有经验的术者推广应用。

Objective：To explore the application value of blunt separation sticking to the ampullae in laparoscopic cholecystectomy with frozen Calot triangle.Methods：The clinical data of 136 cases who underwent laparoscopic cholecystectomy（LC） with frozen Calot triangle from Arp.2006 to Arp.2012 were retrospectively analyzed.Results：LC was successfully completed in 126 cases,and the mean operative time was 52.1 min（40-95 min）.Light red or yellow exudates were drained out with the mean amount of 62 ml/d（30-120 ml/d）.The drainage tube was excluded in 1-4 d with an average of 2 d.The time to get out of bed and take food was in the first day after surgery,same as the normal LC.The mean postoperative hospital stay was 5 d（4-7 d）.No extrahepatic bile duct injury or death occurred.Light bile leakage occurred in 3 cases（2.20%） and was cured by conservative treatment.Laparotomy was performed again in 2（1.47%） cases of unexpected gallbladder carcinoma and 3（2.20%） residual stones in the cystic duct.Five（3.68%） cases were converted to laparotomy for incarcerated gallstones and broken gallbladder.All case recovered well.Conclusions：The application of blunt separation sticking to the ampullae could prevent bile duct injury and decrease laparotomy in cases of frozen Calot triangle,which extends the indications of LC and is worth to be popularized by the experienced surgeons.