胃十二指肠手术史患者的腹腔镜胆囊切除术

目的 :探讨有胃十二指肠手术史患者行腹腔镜胆囊切除术的可行性及疗效。方法 :回顾分析有胃十二指肠手术史 86例的腹腔镜胆囊切除术手术过程。结果 :气腹建立困难 8例 ,腹腔严重粘连无法分离 7例 ,胆囊周围粘连包括Calot三角粘连分离困难 4例均行中转开腹手术。第 1孔穿刺损伤肠管 2例 ,分离粘连时损伤肠管 1例 ,均在腹腔镜下修补。结论 :胃十二指肠手术后腹腔内严重粘连是气腹建立困难或腹腔粘连分离困难而中转开腹的主要原因。第 1孔穿刺肠管损伤和腹腔粘连分离肠管损伤发生率较高。严格掌握手术适应证 ,腹腔镜操作技术娴熟是手术成功的关键

Laparoscopic cholecystectomy in patients with gastroduodenal operative history

Objective:To explore the possibility and effect of laparoscopic cholecystectomy in patients with gastroduodenal history.Methods:The operation procedures of laparoscopic cholecystectomy in 86 cases with gastroduodenal history were retrospectively analyzed.Results:8 cases were difficult in pneumoperitoneum, 7 cases were difficult in separating adhesion of abdominal cavity, 4 cases were difficult in separating adhesion of perigallbladder including Calot triangle. All of them were transferred to open laparotomies. The intestinal canal were injuried by the first point puncture in 2 cases, and separating adhesion in 1 case, and they were repaired under laparoscope.Conclusions:Serious adhesion in abdominal cavity is the main reason of transferring operation. Grasp the operation indication and skillful operation are the keys of success in laparoscopic operation.