腹部手术史患者行腹腔镜胆囊切除术的临床体会

Clinical experiences of laparoscopic cholecystectomy in patients with abdominal operation history

目的:探讨为有腹部手术史患者行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的临床体会。方法:回顾分析2000年2月至2012年10月为86例有腹部手术史患者行LC的临床资料;开放法或闭合法建立气腹,术中松解粘连、显露胆囊,妥善处理胆囊三角,顺逆结合法切除胆囊。结果:82例(95.3%)成功完成LC,手术时间30～85 min,平均(48.2±22.4)min;术中出血量15～90 ml,平均(54.6±32.5)ml;术后住院4～6 d,平均(4.2±1.6)d。4例(4.7%)中转开腹,均系腹腔内广泛致密粘连。6例术中粘连面较广、渗血较多,放置腹腔引流管。术后无肝内外胆管损伤、胆漏、肠漏、肠梗阻、腹腔感染、皮下气肿等并发症发生。结论:正确选择第一穿刺孔,安全建立气腹,术中仔细分离、细致解剖胆囊三角,且术者具备娴熟的腹腔镜操作技巧,为腹部手术史患者行LC是安全、有效的。

Objective ：To discuss the clinical experiences of laparoscopic cholecystectomy （LC） in patients with previous ab- dominal operations. Methods： The clinical data of 86 patients with previous abdominal operations who underwent LC from Feb. 2000 to Oct. 2012 were retrospectively analyzed. Pneumoperitoneum was openly or closedly established, intraperitoneal adhesion was carefully loosened to expose the gallbladder, the Calot triangle was managed properly and gallbladder was resected with along-contrary combina- tive method. Results：LC was successful in 82 cases （95.3%）. The mean operative time was 30-85 min,mean （48.2 ＋22.4） rain,the intraoperative blood loss was 15-90 ml, mean （54.6 _＋ 32.5 ） ml, and the postoperative hospital stay was 4-6 d, mean （4.2 -＋ 1.6） d. 4 cases （4.7%） were convened to laparotomy for extensive intraperitoneal adhesion. Abdominal drainage was performed in 6 cases for extensive adhesion and errhysis. No complications such as injury of intra- and extra-hepatic bile duct, bile leakage, intestinal leakage, in- testinal obstruction, abdominal infection or subcutaneous emphysema occurred. Conclusions： LC is feasible and effective in patients with previous abdominal operations in conditions that the first puncture site was correctly selected ,pneumoperitoneum was safely established, the Calot triangle was finely dissected and the operation was performed by skilled surgeons.