“脱衣法”腹腔镜胆囊切除术的应用

Application of"stripping"technique in laparoscopic cholecystectomy

目的探讨“脱衣法”腹腔镜胆囊切除术(LC)的临床应用价值。方法回顾性分析2014年10月至2018年12月在兰州大学第二医院行“脱衣法”LC的372例患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男131例,女241例;平均年龄(48±13)岁。其中胆囊结石合并慢性胆囊炎336例,慢性胆囊炎急性发作22例,急性化脓性胆囊炎12例,急性坏疽性胆囊炎2例。患者采用创新设计的“脱衣法”行LC,将胆囊三角分离点偏向胆囊颈部,逐层剥离前后胆囊三角内结构,确定左右肝管、胆总管、胆囊管、胆囊动脉、前哨淋巴结等解剖部位,然后离断胆囊管及胆囊动脉等。观察患者围手术期情况。结果患者均采用“脱衣法”顺利完成LC,无中转开腹。手术时间中位数为35(20~50)min,术中出血量15(5~55)ml,术后住院时间5(3~7)d。围手术期无发生死亡,术后无发生胆漏、胆道狭窄等相关并发症。结论“脱衣法”LC是一种安全、有效、简单易学的手术方法,可有效预防胆漏、胆道狭窄等并发症。

Objective To explore the clinical value of"stripping"technique in laparoscopic cholecystectomy(LC).Methods Clinical data of 372 patients who underwent LC using"stripping"technique in the Lanzhou University Second Hospital from October 2014 to December 2018 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,131 patients were male and 241 female,aged(48±13)years on average.336 patients were diagnosed with cholecystolithiasis complicated with chronic cholecystitis,22 cases with acute onset of chronic cholecystitis,12 cases with acute suppurative cholecystitis and 2 cases of acute gangrenous cholecystitis.All patients underwent LC with the innovative"stripping"technique,the Calot's triangle dissecting points of the gallbladder was made deflected to the neck of gallbladder,the inner tissues of anterior and posterior Calot's triangle were dissected layer by layer,the anatomical sites of the left,right hepatic duct,common bile duct,cystic duct,gallbladder artery and sentinel lymph node were pinpointed,and subsequently the cystic duct and gallbladder artery were severed.The perioperative situation of the patients were observed.Results LC using"stripping"technique in all the patients were completed successfully,and no patient was converted to open surgery.The median operation time was 35(20-50)min.Intraoperative blood loss was 15(5-55)ml.The length of postoperative hospital stay was 5(3-7)d.No death occurred during the perioperative period.No bile leakage,biliary stenosis and other postoperative complications occurred.Conclusions"Stripping"technique in the LC is a safe,effective and easy-to-learn procedure,which can effectively prevent the incidence of complications,such as bile leakage and biliary stenosis,etc.