腹腔镜下复杂困难胆囊切除术182例手法技巧的探讨

Experiences in difficult laparoscopic cholecystectomy in 182 cases

目的 :探讨腹腔镜下复杂困难胆囊切除术的手法技巧。方法 :在全麻下对腹腔严重粘连 ,胆囊萎缩、胆囊扩张、解剖变异、术中活动性出血 ,结石掉入腹腔等复杂困难情况 ,行Calot三角精细解剖超常处理。结果 :临床手术 5 89例 ,其中复杂困难手术 182例 ,中转开腹 2例 ,术后胆总管结石梗阻 2例 ,胆汁漏 3例。结论 :术中精细解剖Calot三角是腹腔镜下复杂困难胆囊切除术成功的关键 ,防止周围脏器损伤是成功的基础。术中手下要能分辨出组织 。

Objective:To study the skills of laparoscopy for difficult cholecystectomy .Methods:Under general anesthesia,cases with abdominal cavity serious abhesion, gall bladder atrophy, gall bladder expansion, anatomy variation, active bleeding in the operation, stones dropping into abdominal cavity were operated by Calot triangle fine anatomy. Results: In 182 cases,2 cases were converted to open surgery,2 cases suffered post operational,CBD obstruction with stones,3 cases had bile leakage.Conclusions:Fine anatomy of Calot triangle is the key to the successful operation for diffcult and complex laparoscopic cholecystectomy with the prevention of the damage of nearby organs.