腹腔镜手术治疗急性胆囊炎的临床体会(附47例报告)

Clinical experience of laparoscopic cholecystectomy for acute cholecystitis: with a report of 47 cases

目的：探讨急性胆囊炎行腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）的适应证、手术时机及临床应用价值。方法：本研究回顾分析2012年1月至2015年6月为47例急性胆囊炎患者行LC的临床资料。结果：2例中转开腹,其中1例胆囊三角炎症水肿较重,解剖不清,无法分离、钳夹及解剖胆囊管、胆囊动脉;1例胆囊被大网膜粘连包裹致密,无法分离。45例顺利完成LC,手术时间45-115 min,平均（61.2±21.8）min;术中出血量15-56 ml,平均（28.9±11.3）ml;术后排气时间18-25 h。术后发生胆漏2例,经引流管通畅引流后治愈,余者均无严重并发症发生。术后2-5 d患者出院,平均（2.8±1.5）d。结论：术者具备熟练的腹腔镜操作技术,掌握手术适应证与手术时机,术中适时中转开腹,LC治疗急性胆囊炎是安全、可行的。

Objective： To explore the indication,opportunity and clinical value of laparoscopic cholecystectomy（ LC） in treatment of patients with acute cholecystitis. Methods： The medical records of 47 patients with acute cholecystitis who underwent LC from Jan. 2012 to Jun. 2015 were reviewed retrospectively. Results： All the laparoscopic operations were performed successfully except two cases undergoing conversion to laparotomy. Among the two cases,cystic duct and cystic artery could not be separated,clamped or dissected due to severe edema of Calot triangle in one patient,and in the another patient,gallbladder could not be separated because of tight adhesion between the gallbladder and omentum majus. The average operation time was（ 61. 2 ± 21. 8） min（ range,45-115 min）,and the blood loss was（ 28. 9 ± 11. 3） ml（ range,15-56 ml）. Postoperative exhaust time was 18-25 h. Postoperative bile leakage occurred in2 cases,and cured by the treatment of unobstructed drainage,and no serious postoperative complications were found in others. The mean postoperative hospital stay was（ 2. 8 ± 1. 5） d（ range,2-5 d）. Conclusions： For the acute cholecystitis,on the basis of strict indications and opportunity,sufficient experience of laparoscopic surgery,timely conversion to laparotomy,the LC is safe and feasible.