复杂性胆囊腹腔镜切除术的体会

Experience in laparoscopic cholecystectomy for complicated gallbladder disease

目的探讨复杂性胆囊腹腔镜胆囊切除术（LC）的方法。方法回顾分析2007年8月至2013年11月我科收治的81例复杂胆囊病患者的临床资料，其中急性胆囊炎66例，萎缩胆囊炎14例，Mirizzi综合征1例。所有腹腔镜手术在使用吸引器刮吸分离与超声刀切割相结合下完成。手术历时1．5～3h不等。结果79例Lc手术成功完成，手术中1例肝总管损伤在腔镜下缝合修补，1例术中出血中转开腹手术，1例术前怀疑Mirizzi综合征，手术中确诊中转开腹手术。结论腹腔镜复杂性胆囊切除术安全可行。成功的关健是术前对病例进行认真讨论，术中使用吸引器与超声刀解剖Calot三角，胆囊切除采取顺行与逆行结合。全部切除与部分切除相结合，有效地避免术中大出血和胆管损伤。使腹腔镜下复杂性胆囊切除变得安全可靠。

Objective To investigate the approach to laparoscopic cholecystectomy （LC） in the treatment of complicated gallbladder disease. Methods A retrospective analysis was performed on the clinical data of 81 patients with complicated gallbladder disease admitted to the Department of General Surgery in our hospital from August 2007 to November 2013, including 66 cases of acute cholecystitis, 14 cases of atrophic cholecystitis, and 1 case of Mirizzi syndrome. All laparoscopic operations were completed using the aspirating dissector and ultrasonic knife and lasted for 1.5 - 3 h. Results LC was successfully completed in 79 cases. One case had common hepatic duct injury during operation, which was treated by laparoscopic suture repair; one case had intraoperative bleeding and was converted to laparotomy; one case was suspected of having Mirizzi syndrome before operation and was converted to laparotomy after the syndrome was confirmed during operation. Conclusion Laparoscopic cholecystectomy is safe and feasible in the treatment of complicated gallbladder disease. The key to successful treatment is preoperative evaluation of this disease, intraoperative use of aspirating dissector and ultrasonic knife for dissecting the Calot triangle, antegrade resection combined with retrograde resection, and total resection combined with partial resection, which can effectively avoid intraoperative hemorrhage and bile duct injury.