不保留胆囊管的腹腔镜胆囊切除术

Laparoscopic Cholecystectomy with Total Resection of Cystic Duct

目的探讨不保留胆囊管的腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的安全性、可行性及临床效果。方法回顾性分析2013年3月~2016年1月321例LC的临床资料。采取三孔或四孔法LC,首先解剖出胆总管、胆囊管、肝总管及胆囊动脉"四管"结构;充分游离胆囊管近肝总管汇入部;确认无胆囊管结石后,于近肝总管处夹闭胆囊管并切除胆囊。结果 312例(97.2%)顺利完成不保留胆囊管LC;9例(2.8%)保留0.5 cm~全长胆囊管,包括肝管变异1例(中转开腹),胆囊管汇入点异常4例,萎缩性胆囊炎三角区解剖困难3例,急性坏疽性胆囊炎1例。均无术中胆管损伤、术后胆漏及腹腔大出血等严重并发症。术后随访1~40个月,(23.3±11.0)月,312例不保留胆囊管LC术后无胆管狭窄、胆道残余结石、腹痛、黄疸等表现;9例保留胆囊管病例中,2例术后反复上腹部隐痛症状,未发现结石残留或结石复发。结论不保留胆囊管LC安全、可行,可防止残余小胆囊,避免胆囊管残余结石。

Objective To investigate the safety,feasibility,and clinical effects of laparoscopic cholecystectomy（LC） with total resection of cystic duct. Methods Clinical data of 321 cases undergoing LC from March 2013 to January 2016 were analyzed retrospectively. Three-or four-trocar LC was adopted. Firstly,the common bile duct,cystic duct,common hepatic duct and the cystic artery were carefully dissectd,respectively. Then the cystic duct was fully exposed and clipped nearing its junction with the common hepatic duct by using absorbable clips. Finally the gallbladder with the total cystic duct was resected. Results LC with total resection of cystic duct was successfully performed in 312 cases（97. 2%）. LC with partial（0. 5-1. 0 cm in length） or no resection of cystic duct was carried out in other 9 cases（2. 8%）,including 1 case of hepatic duct variations（converted to open surgery）,4cases of cystic duct outlet abnormity,3 cases of serious inflammation in Calot＇s triangle,and 1 case of acute gangrenous cholecystitis.There were no significant surgical complications,such as bile duct damage,bile leakage or intra-abdominal massive hemorrhea. The follow-up duration after surgery ranged from 1 to 40 months,with an average of 23. 3 ± 11. 0 months. For 312 cases undergoing LC with total resection of cystic duct,there were no obvious clinical symptoms,such as biliary stricture,abdominal pain,jaundice or residual stone of bile duct. Among 9 cases with partial or no resection of cystic duct,2 cases complained of repeated upper abdominal pain after surgery but no residual or recurrent stone was found. Conclusion LC with total resection of cystic duct is safe,feasible and effective and can prevent residual gallbladder and residual stone of cystic duct.