基层医院开展腹腔镜胆囊切除术的效果观察

Clinical Observation of Laparoscopic Cholecystectomy in Primary Hospital

目的观察基层医院开展腹腔镜胆囊切除术的效果。方法选取我院2011年1-12月收治的37例行腹腔镜胆囊切除术患者,采用腹腔镜下行胆囊切除术,观察疗效。结果 35例患者治愈,2例患者中转开腹手术,其中1例为胆囊三角冰冻样粘连,且粘连情况严重,1例患者为出血,且止血困难。术后1例患者出现胆漏,每日最多引流130ml,经引流管引流治疗后,逐渐减少,5d后拔除。1例患者出现感染症状,切开引流后愈合。本组手术时间55～150min,平均手术时间(110±10)min;术中平均出血量(70.8±12.8)ml;术后患者24h左右可下床活动,平均住院时间(5.5±1.0)d,中转开腹患者平均住院时间(8.5±1.2)d。结论腹腔镜行胆囊切除手术作为20世纪逐渐兴起的一项新技术,已广泛应用于各大医院,并以其创伤小、切口小、痛苦小、术后恢复快、时间短、对其他组织影响小等优势,受到临床的广泛欢迎。作为基层医院,在应用此术式时,要注意对患者病情的了解,注意手术操作的熟练程度及并发症的严密观察,加强专业技能的提升,推动基层医院医疗卫生事业的发展。

Objective To observe the hospitals and discusses the application of laparoscopic cholecystectomy significance.Methods Choose our hospital from January 2011 to December 2011 were 37 routine of laparoscopic cholecystectomy patients for clinical material,the downlink laparoscopic cholecystectomy,observation and analysis the clinical curative effect.Results Thirty-five patients were cured and 2 patients transit open surgery,including 1 case of gallbladder triangle frozen samples adhesion,and adhesion severe,1 patients with bleeding,and stop bleeding difficult.After one patients appear bile leakage,most daily drainage 130 ml,the drainage tube after treatment,lower,pulling out after 5 d.1 patients infected symptoms,after incision and drainage healing.The operation time the longest 150 min,the shortest 55 min,average operation time（110±10） min;Intraoperative average blood loss（70.8±12.8）ml;Postoperative patients about 24 hours can bed activities,average hospitalization time（5.5±1.0）d,transfer the length of time the patients with open an average（8.5±1.2）d.Conclusion Laparoscopic gallbladder surgery as the 20 th century the rise of a new technology,has been widely used in the hospital,and with its small trauma,small incision,the pain is small and postoperative recover quickly,time is short and the other organizations such as small effects advantage,by clinical widely welcomed.As the basic unit hospital,in the application of the operation,we should pay attention to the understanding of the disease patients,pay attention to the operation of the skilled degree and the complications of close observation,strengthen professional skills,promote the development of hospital medical and health services.