胆囊管结扎夹闭法在腹腔镜胆囊切除术中处理粗大胆囊管的应用体会(附104例报告)

Ligation and Occlusion of the Cystic Duct during Laparoscopic Cholecystectomy for Patients with Cystic Duct Thickening: Report of 104 Cases

目的探讨胆囊管结扎夹闭技术在腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中处理粗大胆囊管的应用价值。方法 2007年6月～2010年12月,104例LC术中发现粗大胆囊管(直径>0.8 cm),先用丝线结扎使之变细,再用钛夹完全夹闭处理。结果 104例术中胆囊管直径0.8～1.2 cm,手术均获成功,无中转开腹。手术时间40～150 min,平均95 min。无出血、胆漏和腹腔感染等并发症。84例随访3个月～3年,平均1.7年,无腹痛、黄疸及发热等症状。结论对粗大胆囊管先结扎后夹闭的处理方法安全,可靠,成本低廉,特别适合于经济条件相对较差的基层医院应用。

Objective To evaluate the efficacy and the feasibility of ligation and occlusion of the cystic duct during laparoscopic cholecystectomy （LC） for patients with cystic duct thickening. Methods From June 2007 to December 2010, we detected cystic duct thickening （ 〉 0.8 cm in diameter） during LC in totally 104 patients. We used sutures to ligate the cystic duct and then completely occluded the duct with titanium clips. Results The diameter of the cystic duct of the patients ranged from 0.8 to 1.2 cm,and the procedure was completed in all the patients without conversion to open surgery. The mean operation time ranged from 40 to 150 min with a mean of 95 min. No hemorrhage, biliary leakage or intra-abdominal infection occurred. Of the patients, follow-up was achieved for 3 months to 3 years in 84 patients （ mean, 1.7 years） , during which no abdominal pain, jaundice or fever occurred. Conclusions Ligation followed by occlusion is safe, reliable, effective, and economic for cystic duct thickening. The procedure is particularly suitable for primary hospitals.