电凝撕脱法在腹腔镜胆囊切除术中的应用体会

Application experience of electrocoagulation and avulsion in laparoscopic cholecystectomy

目的：探讨电凝撕脱法在腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）中的应用价值。方法：回顾分析2010年1月至2013年12月施行的1 200例LC的临床资料,术中采用电凝撕脱技术。结果：1 189例顺利完成LC,成功率99.1%。由于术中操作困难或发生意外情况,11例中转开腹,中转率0.9%。手术时间21~100 min,平均（47.60±13.40）min;术中出血量5~50 ml,平均（13.10±3.20）ml;术后2~5 d出院,平均住院（5.10±0.67）d。术后随访3~12个月,平均（6.20±1.57）个月,患者均恢复正常生活与工作,术中、术后共发生并发症4例,均经积极处理恢复良好。结论：LC术中采用电凝撕脱法可达到精细解剖,且术中止血更完善,发生医源性副损伤的几率更小;相对降低了手术操作难度与风险,增加了手术操作的安全性,是行之有效的办法,可取得事半功倍的效果,值得推广应用。

Objective： To investigate the application experience of electrocoagulation and avulsion in laparoscopic cholecystectomy（ LC）. Methods： The clinical data of 1 200 cases of LC from Jan. 2010 to Dec. 2013 were retrospectively analyzed,electrocoagulation and avulsion was used in operation. Results： LC was successfully performed in 1 189 patients,the success rate was 99. 1%. 11 cases（ 0. 9%） were converted to laparotomy because of difficult operation or accidents. The operative time was（ 47. 60 ± 13. 40） min（ range,21-100 min）. The blood loss was（ 13. 10 ± 3. 20） ml（ range,5-50 ml）. The hospital stay was（ 5. 10 ± 0. 67） d,postoperative hospital stay ranged from 2-5 d. Patients were followed up for（ 6. 20 ± 1. 57） months（ range,3-12 months）. All patients returned to normal life and work. 4 serious complications were found intra and after operation,and well recovered after positive treatment. Conclusions： The electrocoagulation and avulsion in LC is effective,can finely anatomize,improve intraoperative hemostasis,decrease the incidence of iatrogenic side injury,operative difficulty and risk,increase the operative safety. This procedure deserves to be recommended in the clinical application.