腹腔镜胆囊切除术中伴发腹腔其他疾病的治疗体会

Treatment for Concomitant Diseases of Other Abdominal Organs in Laparoscopic Cholecystectomy

目的总结腹腔镜胆囊切除(LC)术中伴发腹腔其他疾病的治疗经验。方法回顾性分析我院1997年9月至2011年9月期间176例LC术中伴发腹腔其他器官疾病手术的临床资料,其中术前确诊的伴发疾病有肝囊肿53例,胆总管结石15例,慢性阑尾炎7例,腹股沟疝5例,肾囊肿4例,卵巢囊肿6例;术中确诊的伴发疾病有腹腔粘连72例,胆囊消化道内瘘4例,Mirizzi综合征3例,意外胆囊癌7例。结果分别行LC术加肝囊肿开窗术53例、胆总管切开取石术15例、阑尾切除术7例、无张力疝修补术5例、肾囊肿开窗引流术4例、卵巢囊肿剥除术6例、粘连松解术72例、瘘管切除+肠管修补术3例、术中胆道造影术+胆囊管切开取石2例、LC术加胆囊床完整烧灼5例、中转开腹4例(其中肠瘘修补术1例、胆总管切口取石术1例、胆囊癌根治术2例),所有176例均顺利完成手术,恢复顺利,未出现严重并发症。结论严格掌握腹腔镜联合手术的条件和适应证,遵循外科手术原则,腹腔镜手术同时治疗胆囊和腹腔其他疾病是安全、有效的,必要时可选择中转开腹手术。

Objective To summarize the treatment experience for concomitant diseases of other abdominal organs in laparoscopic cholecystectomy（LC）.Methods The clinical data of 176 patients with LC and concomitant diseases of other abdominal organs were analyzed retrospectively,including preoperatively diagnosed cases（such as 53 with liver cyst,15 with choledocholithiasis,7 with chronic appendicitis,5 with inguinal hernia,4 with renal cyst,and 6 with ovarian cyst）and intraoperatively diagnosed cases（such as 72 with abdominal cavity adhesion,4 with internal fistula between gallbladder and digestive tract,3 with Mirizzi syndrome,and 7 with unsuspected gallbladder carcinoma）.Results All the operation were successfully completed in 176 patients without severe complications,including 53 cases treated with LC plus fenestration of hepatic cyst,15 with choledocholithotomy,7 with appendectomy,5 with tension free hernia repair,4 with renal cyst fenestration,6 with oophorocystectomy,72 with adhesiolysis,3 with fistula resection plus intestine neoplasty,2 with intraoperative cholangiography plus choledocholithotomy,5 with LC plus gallbladder bed complete burning,and 4 cases treated with conversion to open surgery（1 with intestinal fistula repair,1 with choledocholithotomy,and 2 with radical resection for gallbladder carcinoma）.Conclusions It is safe and effective to treat gallbladder diseases complicated with other concomitant diseases simultaneously with laparoscopic operation,if the principles of surgical operation are followed and the indications and applicable conditions are strictly followed.And conversion to open surgery is necessary.