腹腔镜胆囊大部切除术的临床应用体会(附468例报告)

Clinical experience of laparoscopic subtotal cholecystectomy(468 cases)

目的探讨腹腔镜胆囊大部切除术的适应证及临床应用体会。方法回顾性分析2012年1月-2015年12月解放军第451医院因无法行腹腔镜胆囊切除术而改为胆囊大部切除术的临床病例资料468例。结果术后无死亡病例发生。7例行腹腔镜胆囊切除术中转开腹胆囊大部切除术,5例Mirizzi综合征(I型3例,II型2例)和456例(各种原因导致的三角区粘连)行腹腔镜胆囊大部切除术。术后无严重并发症出现,16例出现胆瘘,2例十二指肠瘘,适当引流后均痊愈。362例随访时间(21.0±4.9)个月,消化不良18例,右上腹或上腹部不适11例。结论对于胆囊三角区粘连严重的胆结石患者,腹腔镜下胆囊大部切除术是安全可行的,可避免对胆道的损伤,术中和术后重点观察患者胆瘘情况。

Objective To investigate the indication and clinical experience of laparoscopic subtotal cholecystectomy.Methods We performed a retrospective analysis on the clinical data of468patients who underwent laparoscopic subtotal cholecystectomy from January2012to December2015.Results There were no deaths.7cases that underwent laparoscopic cholecystectomy were converted to open surgery with laparoscopic subtotal cholecystectomy.5cases that were diagnosed with Mirizzi syndrome(3cases with type I and2with type II)and456cases underwent laparoscopic subtotal cholecystectomy.No severe complication was detected after surgery.16cases with biliary leakage and2with duodenum leakage.The patients got recovered after a short time of drainage.362cases were followed up and the median follow-up time was(21.0±4.9)months.18ones were with dyspepsia and11ones with upper or right upper discomfort.Conclusion Laparoscopic subtotal cholecystectomy was a safe choice and avoided injury of biliary duct for patients with severe adhesion of calot’s triangle.The biliary leakage should be mainly observed during and after surgery.