胆囊替代定位点在腹腔镜胆囊切除术中的应用

Application of gallbladder alternative location in laparoscopic cholecystectomy

目的：探讨胆囊替代定位点在腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）与经脐单孔腹腔镜胆囊切除术（transumbilical laparoendoscopic single site cholecystectomy,TU-LESS-C）中降低医源性胆管损伤的意义与应用方法。方法：回顾分析2994例LC或TU-LESS-C患者的临床资料,手术均在钟士镇院士提出的胆囊替代定位点原则指导下施行,并结合国内外文献复习进行总结。结果：2 994例均参照胆囊替代定位点原则完成手术。手术时间15～90 min,平均（45±15）min;术中出血量1～50 ml,平均（5±4）ml（以干纱布称重法计算）。术后6～24 h下床活动;胃肠功能恢复时间平均（24±12）h;术后住院2～7 d,平均（3±1）d。术后发生胆管损伤3例,发生率0.1%,其中肝总管迟发性损伤胆漏1例,胆总管部分夹闭梗阻1例,肝总管横断伤1例。术后患者均获随访,随访1～84个月,患者均恢复良好,对治疗效果、美容效果满意。结论：胆囊替代定位点对于预防胆总管损伤具有重要指导意义,但并不能防止肝总管及高位胆管的损伤。

Objective：To investigate the application methods of gallbladder alternative location in laparoscopic cholecystectomy （LC） and transumbilical single-port LC, and its significance in reduction of iatrogenic bile duct injury. Methods ： Guided by principle of gallbladder ahemative location proposed by academician ZHONG Shi-zhen,2 994 patients underwent LC or transumbilical single-port LC, their clinical data were retrospectively analyzed, summarized with domestic and foreign literatures. Results ： All operations were com- pleted under principle of gallbladder alternative location. The operative time was （45 ± 15 ） min （ range ： 15-90 min）. The mean intraop- erative blood loss was （5 ± 4） ml （range：1-50 ml） which was calculated by dry gauze weighing method. Postoperative ambulation time was 6-24 h. The mean time to recovery of gastrointestinal function was （24 ± 12） h,and the mean hospital stay was （3 ± 1 ） d （range： 2-7 d）. Postoperative bile duct injury occurred in 3 cases （0.1%） ,including 1 case of delayed injury of common hepatic duct and bile leakage, 1 case of partial occlusion and obstruction of common bile duct, 1 case of common hepatic duct transection injury. All patients were followed up for 1 to 84 months, they recovered well, satisfied with therapeutic and cosmetic results. Conclusions ： Gallbladder alternative location plays an important role in prevention of common bile duct injury for LC and transumbilical single-port LC, but could not prevent injury of common hepatic duct and high bile duct.