腹腔镜胆囊切除术中胆囊管的处理体会(附1500例报告)

Treatment experience of bile duct in laparoscopic cholecystectomy:with a report of 1500 cases

目的：探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）中胆囊管的正确处理方法。方法：回顾分析2010年1月至2014年9月为1 500例患者行LC的临床资料。结果：1 500例患者术中根据具体情况采用不同的胆囊管处理方式,其中1 493例顺利完成LC,手术成功率99.53%;7例由于操作困难、术中发生意外情况中转开腹,中转率0.47%。手术时间30～100 min,平均（47.60±17.40）min;术中出血量5～50 ml,平均（13.10±5.20）ml;术后2～5 d出院,平均住院（5.10±0.67）d。术中、术后共发生较严重的并发症4例,经积极处理均恢复良好。结论：LC术中正确处理胆囊管与胆囊管结石是有效预防术后并发症发生、确保手术成功的关键因素之一。对于胆囊管的处理应根据胆囊管的粗细、长短、炎症水肿、瘢痕增生程度、有无解剖变异及结石占位等情况综合评估,进行个体化处理。

Objective：To investigate the correct treatment of bile duct in laparoscopic cholecystectomy （LC）. Methods：The clinical data of 1 500 patients who underwent LC from Jan. 2010 to Sep. 2014 were retrospectively analyzed. Results：Different treat- ments were used in the 1 500 cases of LC according to individualized conditions, 1493 cases of LC were successful, the success rate was 99.53 %. 7 patients were converted to laparotomy because of difficult operation or accidents, the conversion rate was 0.47 %. The opera- tive time was （47.60 ± 17.40） min （ range,30-100 min） ;the operative blood loss was （ 13.10 ± 5.20） ml （ range,5-50 ml） ,postoper- ative hospital stay was （5.10 ±0.67） d （range,2-5 d）. Serious intraoperative or postoperative complications occurred in 4 patients, who recovered well after positive treatment. Conclusions：Correct treatment of bile duct and calculi in bile duct plays an important role in effective prevention of postoperative complications and guarantee of successful operation. Treatment of bile duct should be individual- ized and comprehensively assessed according to width, length, inflammation, edema, scar, hyperplasia, anatomic variation of bile duct and calculi location.