急性胆囊炎腹腔镜胆囊切除术93例体会

目的总结腹腔镜下处理急性胆囊炎的临床经验。方法回顾性分析2003年5月-2005年5月93例急性胆囊炎行腹腔镜手术治疗的临床资料，其中15例术前确诊胆总管结石而先行内镜逆行胰胆管造影（endoscopic retrograde cholangiopancreatography，ERCP）联合内镜括约肌切开（endoscopic sphincterotomy，EST）取石，6例疑似胆道结石者行术中胆道造影。均于48h内完成LC。结果91例（97．8％）手术成功，2例（2．2％）中转开腹。手术时间35—160min，平均65min。术后胆囊管残端漏3例（3．2％），胆道残余结石3例（3．2％），经开腹手术结合ERCP、EST、鼻胆管引流（endoscopic nasobiliary drainage，ENBD）治愈，全组无医源性损伤。结论选择性应用ERCP和EST，腹腔镜胆囊切除术治疗急性胆囊炎是安全可行的，但中转开腹及并发症的发生率高。

Experience of 93 cases of laparoscopic cholecystectomy for acute cholecystitis

Objective To summarize the clinical experience of laparoscopic cholecystectomy (LC) in the treatment of acute cholecystitis. Methods A total of 93 cases of acute cholecystitis treated by LC from May 2003 to May 2005 was retrospectively reviewed, including 15 cases of preoperative endoscopic retrograde cholangiopancreatography (ERCP) combined with endoscopic sphincterotomy (EST) for common bile duct stones and 6 cases of intraoperative cholangiography. The LC was performed within 48 hours after admission. Results The LC was successfully completed in 91 cases (97.8%), whereas a conversion to open surgery was required in 2 cases (2.2%). The operation time was 35~160 min (mean, 65 min). Postoperatively, biliary leakage occurred in 3 cases (3.2%) and residual stones in the common bile duct were found in 3 cases (3.2%), which were all cured by open surgery combined with ERCP, EST, and endoscopic nasobiliary drainage (ENBD). No iatrogenic injuries happened. Conclusions With proper selection of ERCP and EST, LC for the treatment of acute cholecystitis is feasible and safe. But the incidence of conversions and complications may be high.