腹腔镜治疗急性结石性胆囊炎的临床体会

目的探讨腹腔镜胆囊切除(laparoscopic cholecystectomy,LC)治疗急性结石性胆囊炎操作技巧及临床体会。方法回顾分析皖北煤电集团总医院2005年1月-2010年12月110例急性结石性胆囊炎行腹腔镜治疗的临床资料。结果 104例成功完成LC,手术时间40～145 min,平均70 min,术后1～3 d恢复进食,术后住院4～7 d,平均5 d,术后1例胆囊床出血保守治愈,1例脐部感染抗炎换药治愈,术中无胆管损伤、胆漏、内脏损伤及腹腔感染等严重并发症发生;6例中转开腹(4.5%),转开腹原因:3例胆囊三角粘连致密无法分离,1例胆囊动脉出血,1例Mirizzi综合征,1例术中造影发现胆总管结石。术后随访3个月～1年,无腹痛胆管狭窄及黄疸等并发症发生。结论熟练掌握腹腔镜的基本操作及技巧,严格掌握手术适应症,并具备娴熟的开腹胆道处理能力,急性结石性胆囊炎行腹腔镜胆囊切除是安全可行的。

Clinical Experience for Acute Calculous Cholecystitis by Using Laparoscope

Objective To investigate the operative techniques and clinical experience of using laparoscopic cholecystectomy(LC) in the treatment of acute calculous cholecystitis.Methods The clinical data of 110 cases of acute calculous cholecystitis treated with LC in our hospital from in January 2005 to December 2010 were analyzed retrospectively.Results LC was successfully performed in 104 cases,operation time was 40-145 min(mean 70min).The patients resumed taking foods within 1 to 3 days.The hospital delay was 4-5 days,average 5 days after the operation.1 case was with gallbladder bed bleeding and cured by conservative method;1 case with umbilical infection and cured by antibiotic treatment;there was no other serious complications such as bile duct injury,biliary leakage,visceral injury and abdominal infection in the operation.6 cases were converted to open surgery(4.5%) because of dense adhesions in the Calot’s triangle(3 cases),cystic artery bleeding(1 case),Mirizzi syndrome(1 case) and common bile duct stone(1 case).The follow-up was 3 months to 1 year,complications such as abdominal pain,jaundice stenosis and bile duct were not found.Conclusion LC for acute calculous cholecystitis is safe and feasible.The doctors should master the basic laparoscopic operations and techniques,strict control the indications for operation and have well-developed open biliary processing ability.