腹腔镜急性胆囊炎手术方法与技巧分析

Analysis of the skill and methods of laparoscopic operation in the treatment of acute cholecystitis

目的：探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）治疗急性胆囊炎的手术方法与技巧。方法：回顾分析2000年2月至2012年11月3700余例LC患者的临床资料，其中急性胆囊炎485例。结果：485例患者中461例手术获得成功，23例中转开腹，1例因胆道损伤行“T”管引流术后治愈，余者均放置腹腔；1流管。术后均未发生胆漏、出血及严重并发症，术后2～4d拔除腹腔引流管，患者痊愈出院。结论：随着腹腔镜技术的成熟及器械设备的完善，术中充分暴露胆囊三角区、辨清三管关系并把握中转开腹的指征、注意操作技巧与方法，可有效预防胆总管损伤等并发症，为急性结石性胆囊炎患者行LC是安全、可靠的。

Objective：To discuss the skill and methods of laparoscopic cholecystectomy in the treatment of acute cholecystitis. Methods ：The clinical data of 3 700 patients who underwent laparoscopic cholecystectomy between Feb. 2000 and Nov. 2012 were retrospectively analyzed,including 485 patients who suffered from acute cholecystitis. Resalts：Laparoscopic cholecystectomy for acute chole- cystitis was performed successfully in 461 cases,23 cases were converted to open surgery, 1 case received T-tube drainage due to bile duct injury. The remainder were placed abdominal drainage tube. No serious complications such as hemorrhage, bile leakage occurred postoperatively. Abdominal drainage tubes were removed 2-4 d after operation, and all patients were discharged from hospital. Conclu- sions ：Along with the maturity of laparoscopic technology and the perfection of equipment and appliances, bile duct injury and other complications can be effectively prevented, laparoscopic cholecystectomy in the treatment of acute calculous cholecystitis is safe and reliable based on sufficient exposure of the Calot triangle, distinction the relationship of the three tubes, grasping the indications for converting to open surgery, paying attention to skills and methods in operation.