胃大部切除术后腹腔镜胆囊切除术

Laparoscopic cholecystectomy of benign diseases of the gallbladder after subtotal gastrectomy

目的 探讨胃大部切除术后腹腔镜胆囊切除 (LC)的可行性及手术方法和技巧。 方法 16例胃大部切除术后胆囊良性疾病 (胆囊结石 13例 ,胆囊息肉样病变 3例 )行LC。采用闭合法建立气腹 ,分离粘连 ,松解悬吊于肝门部的十二指肠残端、结肠肝曲及网膜等 ,显露胆囊全貌及Calot三角 ,按常规切除胆囊。 结果 16例中LC成功 15例 ,因胆囊管难以辨认中转开腹胆囊切除 1例 ,全组无出血、内脏损伤、胆漏和胆道损伤等并发症发生。 结论 胃大部切除术后胆囊良性疾病LC可行 ,可达到常规LC的良好效果。

Objective To investgate the practicability and technical skill of laparoscopic cholecystectomy (LC) for patients with a history of subtotal gastrectomy. Methods LC was performed in 16 patients with benign diseases of gallbladder after subtotal gastrectomy. 13 of them diaguosed as cholecystolithiasis and 3 as polyps. Pneumoperitoneum was formed by Close method. Under laparoscope, intraperitoneal adhesion was loosened; duodenal stump or/and colon transversum adhered to portal hepatis was separated; the anatomical position of gallbladder and Calot's triangle were exposed clearly. Finanally, the cholecystectomy was conducted through routire LC. Results Pneumoperitoneum formed by Close method, loosening of intraperitoneal adhesion and exclusion of duodenal stump or/and colon transversum adhered to porta hepatis were successful in all of the cases. And LC was conducted successfully in 15 cases, and open cholecystectomy (OC) was done in another one becasue of mistaking cystic duct with adhesive band. No complications of intraperitoneal hemorrhage, abdominal visceral injury, biliary spillage, trauma of biliary duct was found Conclusions LC is to be test considered first in the treatment of benign diseases of gallbladder such as cholecystolithiasis and cystic polyps after subtotal gastrectomy and the curative effects are the same as those of roatine LC.