论文部分内容阅读
目的总结腹腔镜胆囊切除术(LC)治疗急性结石性胆囊炎的临床经验。方法对我院149例急性结石性胆囊炎患者行LC术的临床资料进行回顾性分析总结。结果 145例完成LC,其中2例术中肝总管撕裂,行腹腔镜下缝合,完成手术。4例中转开腹,其中3例因胆囊三角与周围组织粘连致密,或胆囊三角区解剖关系不清;1例因术中出血镜下止血困难,中转开腹;手术时间50～180min。术后发生胆漏3例,均经引流管引出,引流量每日逐渐减少,1周左右停止后拔管观察痊愈出院。切口感染、液化12例;术后住院时间5～8d。所有患者跟踪随访8～12个月均无异常。结论急性结石性胆囊炎并非LC禁忌证,实施LC安全可行,成功的关键在于手术技巧、耐心操作、适时中转、可降低并发症的发生。
Objective To summarize the clinical experience of laparoscopic cholecystectomy (LC) in the treatment of acute calculous cholecystitis. Methods The clinical data of 149 patients with acute calcific cholecystitis in our hospital were analyzed retrospectively. Results 145 cases completed LC, of which 2 cases of intraoperative hepatic duct tears, laparoscopic suture to complete the operation. 4 cases converted to laparotomy, of which 3 cases due to dense adhesion around the gallbladder triangle and the surrounding tissue, or anatomical relationship between the gallbladder trigone area is not clear; 1 case due to intraoperative bleeding hemostasis difficulties, transit laparotomy; operation time 50 ~ 180min. Postoperative bile leakage occurred in 3 cases, both of which were educed by drainage tube. The drainage volume decreased gradually every day and extubation was observed after 1 week or so. Incision infection, liquefaction in 12 cases; postoperative hospital stay 5 ~ 8d. All patients were followed up for 8 to 12 months were no abnormalities. Conclusions Acute cholecystitis cholesteatum is not a LC contraindication. It is safe and feasible to implement LC. The key to success lies in surgical skills, patient operation and timely transit, which can reduce the incidence of complications.