腹腔镜胆囊切除术中钛夹联合生物夹的应用体会(附52例报告)

Clinical effect of titanium clips combined with biological clips on laparoscopic cholecystectomy:with a report of 52 cases

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中联合应用钛夹与生物夹的手术技巧。方法:回顾分析2011年1月至2012年12月为52例患者行LC的临床资料,术中联合应用钛夹与生物夹。结果:本组52例均顺利完成LC,手术时间30～120 min,较未联合应用钛夹与生物夹时缩短10～20 min;Calot三角解剖出血的患者术中出血量30～50 ml,较原来减少20～30 ml;术后肠功能恢复时间6～24 h,住院3～5 d。术后发生脐部切口感染2例,均为急性胆囊炎急诊行LC的患者,经保守治疗愈合;余均恢复良好,无术中胆道损伤、术后胆漏及继发胆总管结石等严重并发症发生。术后均获定期随访,1例因急性胆管炎住院治疗1次,余均顺利康复。结论:LC术中,术者对Calot三角区分离的管道组织不能完全定性或解剖Calot三角时出血剧烈、胆囊颈管嵌顿结石时,充分利用钛夹与生物夹的特性,联合应用可有效避免术中胆道损伤、继发性胆总管结石等严重并发症。此方法行之有效,事半功倍。

Objective ： To explore the surgical technique of combined application of titanium and biological clips in laparoscopie cholecystectomy （LC）. Methods：A retrospective analysis was made on clinical data of 52 patients undertaking LC from Jan. 2011 to Dee. 2012. Titanium clips were used together with biological ones intraoperatively. Results：LC was conducted successfully in 52 cases. The operative time was 30-120 min,whieh was shorter than the time without combination of titanium clip and biological clip for 10- 20 min. The blood loss of patients who suffered from hemorrhage at Calot triangle was 30-50 ml, which was less than before for 20- 30 ml. Postoperative recovery time of intestinal function was 6-24 h, and hospital stay was 3-5 d. 2 cases previously diagnosed as acute eholecystitis had postoperative umbilical incision infection, and were cured by conservative treatment. Others recovered well without seri- ous complications, such as intraoperative bile duct injury, postoperative bile leakage, and secondary common bile duct lithiasis. All patients had well-documented postoperative follow-up and recovered well, except for one that had hospitalization because of acute cholangitis. Conclusions：Under the circumstances during LC, such as difficulty in well defining pipeline tissue in Calot triangle region, severe hemorrhage at Calot triangle and incarcerated stones in the neck of gallbladder, titanium and biological clips can be efficiently applied together after full understanding their characteristics, which is effective in preventing severe complications, such as intraoperative bile duct injury and secondary common bile duct lithiasis.