1478例急性胆囊炎腹腔镜胆囊切除术手术技巧分析

Clinical analysis of 1478 acute cholecystitis patients underwent laparoscopic cholecystectomy

目的探讨急性胆囊炎行腹腔镜胆囊切除术的手术技巧及安全性。方法回顾分析2007年4月～2012年4月1478例急性胆囊炎患者行腹腔镜胆囊切除术的临床资料。结果成功完成LC 1435例,43例中转开腹,中转开腹率2.9%,其中胆囊三角致密粘连27例,胆囊结肠内瘘3例,胆囊十二指肠内瘘2例,mirizzi综合征5例,术中出血6例。患者均顺利出院,随访3～12个月,无严重并发症发生,手术治愈率100%。结论严格按照腹腔镜手术基本原则,掌握如下手术技巧:①发病后72h手术;②采用4孔法并使胆囊周围组织形成张力游离胆囊;③采用多种措施提高胆囊三角的处理质量;④游离胆囊时宁浅勿深。急性胆囊炎行LC是安全可行的。

Objective To summarize the safety and skills of laparoscopic cholecystectomy （LC） in tile treatment of acute choleeystitis. Methods Comprehensive analysis of the clinical data from 1478 acute cholecystitis patients underwent LC in our center during April 2007 to April 2012 retrospectively. Results LC was successfully performed in 1435 patients, while 43 cases were transferred to open cholecysteetomy.（2.9% ）. Of all, tight adhesions of Calot＇s triangle were seen in 27 patients, 5 patients suffered from Mirizzi syndrome. Duodenum-gall bladder fistula or coloia-gall bladder fistula was found in 2 and 3 cases respective- ly. However, only 6 patients experienced of intraoperative bleeding. No severe complications occurred in all patients followed up, in detail, from 3 to 12 months out of hospital. Conclusion LC is feasible and safe in treating acute eholeeystitis i（ surgeons pos- sess the followed principles and skills： ①Perform operation after 72h of medical treatment; ②Adopt 4-hole method io make the connective tissues around gall bladder much more easily being dissociated; ③lmprove the quality of dissecting Calot＇s trianle; ④ prefer superficial to deeply when dissociating gall bladder.