摘要
目的 探讨腹腔镜胆囊切除术适应症的选择,术中注意事项,避免副损伤的技巧和术后并发症的处理原则。方法 对438例各类胆囊疾病行腹腔镜胆囊切除术术中情况及应变措施,术后发生胆汁瘘的处理方法和效果进行了分析与总结。结果 中转开腹8例,术后开腹3例,术后胆汁瘘共12例,其中9例行保守治疗治愈。结论 慢性结石性胆囊炎引起的废用性胆囊选择腹腔镜手术要慎重,术中根据calot三角情况采用最佳处理方法,术后胆瘘在胆汁流量较少情况下可观察一周再决定是否开腹手术。
Objective To explore the indications, matters needing attention during operation, management of postoperative complications in laparoscopic cholecystectomy: Methods The status during operation, emergency measures,and measures for postoperative biliary fistula in 12 cases were reviewed retrospectively in 438 cases of laparoscopic cholecystectomy(LC).Results There were 1.83%(8/438)of the LC conversed to laparotomy.Three cases were laparotomized after LC. Nine cases of postoperative biliary fistula were cured by non-operative measure.Conclusion Care should be taken in chosing LC for disuse gallbladder with chronic lithic angiocholitis.During operation, best step should be adopt according to the condition of Calot triangles. In case of postoperative biliary fistula observation for a week is needed for deciding the necessity of laparotomy when the biliary flow is scanty.
关键词
腹腔镜
胆囊切除术
胆瘘
Laparoscopic
cholecystectomy
biliary fistula.