急性化脓性胆囊炎LC手术的困难及对策

Difficulties and countermeasures of acute suppurative cholecystitis LC surgery

目的探讨急性化脓性胆囊炎(acute suppurative cholecystitis,ASC)腹腔镜胆囊切除术(laparoscopic chole-cystectomy,LC)的可行性及手术方法。方法对我院2007年1月～2011年12月143例因胆囊颈结石嵌顿所致的急性化脓性胆囊炎LC手术(发病48h～72h 95例,>72h48例)的临床资料进行回顾性总结。结果中转开腹15例(10.5%);术中出血>100ml 13例(0.9%),胆管损伤1例(0.7%),胆漏6例(4.2%),无死亡患者。结论解剖结构变异及"三管"显示不清和出血是急性化脓性胆囊炎LC手术的困难点,采用"冷热交替、软硬兼施"的"切、分、推、吸"的解剖法,可以完成高危病理条件下的LC手术。

Objective To discuss the feasibility of laparoscopic cholecystectomy(LC) which is useful for acute suppurative cholecystitis(ASC) and the surgical method of LC.Methods We will look back and summarize 143 copies of clinical datas of our hospital from January 2007 to December 2011.All of the patients contracted ASC which was leaded to by an impacted stone in the gallbladder neck.95 patients' disease time were from 48 hours to 72 hours and 48 patients' disease time exceeded 72 hours when we adopted LC.Results 15 patients relied on laparotomy and the rate of these case loads was 10.5%.13 patients' haemorrhages exceeded 100 milliliter and the rate of these case loads was 0.9%.1 patient's bile duct was damaged and the rate of this case load was 0.7%.6 patients' bile was leaked and the rate of these case load was 4.2%.There is no death case.Conclusion It is the difficulty in the LC operation of ASC that anatomica variations and l not clear of the Three tube(bile duct,Cystic duct,cystic artery) and haemorrhage if we use a anatomical method that is the carrot and stick and alternating hot and cold include cutting、separating、pushing、suctioning.we will complete the LC operation in the highly risk of pathologic conditions.