困难性腹腔镜胆囊切除术围手术期处理体会

Experience in perioperative management in difficult laparoscopic cholecystectomy

目的探讨困难类型腹腔镜胆囊切除围手术期的处理方法及并发症的预防。方法利用回顾性分析临床资料的方法,选择广东省中山大学附属东华医院1999年-2013年10月82例因急性胆囊炎、Mirizzi综合征、腹部手术史伴腹腔严重粘连、萎缩性胆囊炎、合并肝硬化等困难类型腹腔镜胆囊切除术的临床资料,总结经验和教训。结果除6例中转开腹(占7.31%)外,余均用腹腔镜成功完成手术;术后胆道损伤、胆瘘2例,再次手术后治愈;术后出血4例,保守治疗后痊愈;术后不明原因、不同程度胆漏者10例,经引流后自愈。结论对于困难类型腹腔镜胆囊切除术,虽然手术操作难度大,风险高,只要围手术期处理方法适当,仍可以在腹腔镜下完成手术。

Objective To investigate perioperative management and the prevention of complications in difficult laparoscopic cholecystectomy. Methods A retrospective analysis was performed on the clinical data of 82 patients,who underwent difficult laparoscopic cholecystectomy due to acute cholecystitis,Mirizzi syndrome,a history of abdominal surgery with severe abdominal adhesion,atrophic cholecystitis,liver cirrhosis with gallstones,and other diseases in our hospital since 1999,to summarize the experiences and lessons. Results Among all patients,6（ 7. 31%） were converted to open laparotomy,and other patients were successfully treated by laparoscopic cholecystectomy.Postoperative biliary injury and biliary fistula occurred in 2 cases,and they were cured after reoperation. Postoperative bleeding occurred in4 cases,and they were cured with conservative treatment. Different degrees of biliary leak of unknown causes occurred in 10 cases,and they were cured after drainage. Conclusion For difficult laparoscopic cholecystectomy,surgical operation is characterized by high difficulty and high risk,but it can still be completed with proper perioperative management.