腹腔镜胆囊大部切除在calot三角呈冷冻样粘连时的临床应用

目的 探讨急性胆囊炎ealot三角呈冷冻样粘连时急诊腹腔镜手术治疗。方法 回顾性分析我院2002年1月-2005年9月74例急性胆囊炎calot三角冷冻样粘连时腹腔镜胆囊大部切除的临床资料、手术方式、近期及远期并发症。结果 74例腹腔镜胆囊大部切除术中，71例手术获得成功，占95．9％；Mifizzi综合征术中无法确认胆囊管是否有结石及术中无法确认胆囊十二指肠瘘中转开腹各1例，占2．7％；术后胆囊管结石再次手术1例，占1．3％；术后少量胆漏1例，占1．3％。术中胆管造影4l例，39例造影显示无异常，2例失败。无死亡病例。结论 急性胆囊炎ealot三角呈冷冻样粘连时，选择腹腔镜胆囊大部切除术是安全、有效的，可预防胆管损伤和降低手术中转率。

Laparoscopic Management of Acute Cholecystitis with Subtotal Cholecystectomy

Objective To discuss the clinical application of lapraroscopic subtotal cholecystectomy in the acute cholecystitis with severe inflammatory and fibrous adhesions at calot triangle.Methods Retrospective analysis of the clinical data,surgical approaches,and short term and long term complications of 74 cases of acute cholecystitis in the period from January 2002 to September2005 in our hospital.Results In the 74 cases operated by subtotal cholecystectomy using laparoscopy,during laparoscopic procedure,71(95.9%) operations were successful;a case of Mirizzi syndrome could not be confirmed to have the residual stones in cystic duct and another case of the same syndrome was not confirmed to have the duodenum fistula.These two cases were then dealt with by conventional surgery and constituted 2.7% of the total cases.One case was dealtd with by second surgery because of the residual stones of cystic duct after lapraroscopic subtotal cholecystectomy and constituted 1.3% of the total cases.One case was found with minor bile leakage and constituted 1.3% of the total cases.Cholangiography was conducted 41 cases during operation,of whom,39 cases were normal and 2 cases failed.No death occurred with the operation of the lapraroscopic subtotal cholecystectomy.Conclusion It is safe and effective to apply laparoscopic subtotal cholecystectomy to treat acute cholecystitis with severe inflammatory and fibrous adhesions at calot triangle.