损伤控制外科理念下腹腔镜胆囊开窗次全切除术+大网膜填塞治疗Calot三角冰冻萎缩性胆囊炎的临床体会

The application of laparoscopic fenestration and subtotal cholecystectomy with greater omentum tamponade for the treatment of Calot triangle frozen atrophic cholecystitis under the concept of injury control surgery

目的:探讨损伤控制外科理念下腹腔镜胆囊开窗次全切除术+大网膜填塞治疗Calot三角冰冻萎缩性胆囊炎的手术要点及应用价值。方法:回顾分析2010年10月至2015年10月收治的26例Calot三角冰冻萎缩性胆囊炎患者行腹腔镜胆囊开窗次全切除术+大网膜填塞的临床资料。结果:手术均顺利完成,无医源性胆管损伤、术后腹腔内出血、中转开腹、围手术期死亡病例,患者均顺利出院。手术时间平均(95.5±13.6)min;术中出血量平均(27.4±6.7)ml;平均住院(9.1±2.5)d。术后发生胆漏3例,经腹腔双套管充分引流后治愈;腹腔感染2例,1例与胆漏有关,1例与腹腔积液有关,保守治疗后治愈。术后随访2年,无死亡病例及胆漏、残留小胆囊、胆囊管结石残留、残留胆囊壁癌变发生。结论:腹腔镜胆囊开窗次全切除术+大网膜填塞治疗Calot三角冰冻萎缩性胆囊炎符合损伤控制外科理念,是安全、可行的。

Objective： To introduce the concept of damage control surgery in the treatment of atrophic cholecystitis,and discuss the operative points and application value of laparoscopic fenestration and subtotal cholecystectomy with greater omentum tamponade for the treatment of Calot triangle frozen atrophic cholecystitis. Methods： The clinical data of 26 patients diagnosed with Calot triangle frozen atrophic cholecystitis from Oct. 2010 to Oct. 2015 and underwent laparoscopic fenestration and subtotal cholecystectomy with greater omentum tamponade were retrospectively analyzed. Results： All operations were successful without iatrogenic bile duct injury,postoperative abdominal bleeding,conversion to laparotomy or perioperative death. All patients were uneventfully discharged. The operation time was（ 95. 5 ± 13. 6） min,the amount of bleeding in the operation was（ 27. 4 ± 6. 7） ml,and the time of hospitalization was（ 9. 1 ±2. 5） d. Bile leakage in 3 cases was cured by abdominal double-cannula after sufficient drainage. Abdominal infection in 2 cases（ 1 case with bile leakage and 1 case with peritoneal effusion） was cured after conservative treatment. There was no death,bile leakage,residual gallbladder,residual bile duct calculi or residual gallbladder wall cancer after 2 years of follow-up. Conclusions： Laparoscopic fenestration and subtotal cholecystectomy with greater omentum tamponade is a safe and feasible alternative for the treatment of Calot triangle frozen atrophic cholecystitis,and is consistent with the concept of injury control surgery.