普通吸引器刮吸法行急性胆囊炎腹腔镜胆囊切除术

2006年6月～2011年12月,对106例急性胆囊炎行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC),病程1 d～2周,其中62例病程>3 d。三孔法44例,四孔法62例。用腹腔镜普通吸引器边钝性分离胆囊颈管和胆囊床,边吸引保持术野清晰,超声刀处理胆囊动脉和止血,胆囊颈管结扎或缝合处理,38%(40/106)留置温氏孔腹腔引流管。顺利完成手术105例,1例因胆囊颈管损伤中转开腹。手术时间42～86 min,平均56 min;出血量45～150 ml,平均86 ml。术后胆漏4例,1例行鼻胆管引流1周痊愈,3例腹腔引流3～7 d痊愈。认为使用普通吸引器刮吸法可以较清晰地显露胆囊周围各层间的解剖关系,使腹腔镜下急性胆囊炎手术变得更安全和易于成功。

Laparoscopic Cholecystectomy with Curettage and Suction by Using General Aspirator for Acute Cholecystitis

From June 2006 to December 2011,we performed laparoscopic cholecystectomy(LC) on 106 patients with acute cholecystitis.The course of the disease ranged from 1 day to 2 weeks(>3 days in 62 cases).LC was carried out through three ports in 44 cases,and four ports in the other 62.By using a general aspirator,we separated the gallbladder neck and bed.With continuous suction to keep the surgical field clear,we cut the cystic artery with ultrasonic scalpel and controlled bleeding.Afterwards,the gallbladder neck was ligated or sutured.Winslow’s foramen drainage tube was indwelt in 40 of the 106 patients(38%).The procedure was completed in 105 of the patients,and one of them was converted to open surgery because of injury to the gallbladder neck.The operation time ranged from 42 to 86 minutes with a mean of 56 minutes,and the intraoperative blood loss was 86 ml in average(ranged from 45 to 150 ml).Postoperative biliary leakage was found in four patients,while one of them was cured in one week by endoscopic nasobiliary drainage,and the other three were cured by abdominal drainage in 3 to 7 days.We believe that with curettage and suction by a general aspirator,the anatomy of the gallbladder can be shown clearly so that LC for acute cholecystitis is easier and safer.