顺逆结合胆囊切除在腹腔镜胆囊切除术中的应用

The application of along-contrary combinative cholecystectomy in laparoscopic cholecystectomy

目的 :探讨顺逆结合胆囊切除在腹腔镜胆囊切除术 (LC)中的应用价值。方法 :对 6 0 0例结石性胆囊炎、胆囊息肉患者 ,采用顺逆结合法行LC手术。结果 :6 0 0例患者术后均顺利康复 ,无胆管损伤等并发症发生。术中将胆囊完全游离后发现 ,把 8例的胆总管误认为胆囊管夹闭 ,2例各有一与肝总管平行的副肝管汇入钛夹远端的胆囊管 ,11例在钛夹近端的胆囊管内有结石嵌顿 ,而术前B超未提示胆囊管内有结石嵌顿 ;均及时取除钛夹后 ,重新夹闭胆囊管的近端和远端 ,再切除胆囊。结论 :在LC手术中 ,采用顺逆结合法切除胆囊 ,可有效地减少胆管损伤。

Objective:To explore the applicative value of along contrary combinative cholecystectomy in laparoscopic cholecystectomy(LC).Methods:600 patients with stone cholecystitis and gallbladder polyps were undergone laparoscopic cholecystectomy (LC).The cystic duct and artery were divided firstly and clipped with titanium folder. When gallbladder was dissociated completely the cystic dust was cut off and the gallbladder was resected. Results:600 patients recovered smoothly. No complications such as common bile duct damage occurred. During operation, when gallbladder was dissociated completely, 8 patients were found that the common bile duct was clipped as cystic duct by first titanium folder. In 2 patients, there was an accessory hepatic duct which paralleled the common bile duct remitted into the distal cystic duct to the first titanium folder. In 11 patients, there were small stones in the approximate cystic duct to the first tianium folder that B mode did not discover before operation, For these patients, the first titanium folder was taken out. The cystic ducts were clipped again and the gallbladder was resected. Conclusions:Using along contrary combinative cholecystectomy in laparoscopic cholecystectomy, the complications such as common bile duct damage, remaining stones in cystic ducts can be reduced.