腹腔镜胆囊大部切除术不闭锁缝合胆囊残端的可行性研究

目的:探讨残留部分胆囊壶腹或困难胆囊行腹腔镜胆囊大部切除术不闭锁缝合胆囊残端的可行性。方法:总结2006年1月至2008年3月16例Calot三角解剖困难患者行腹腔镜胆囊大部切除术中残留部分胆囊壶腹或胆囊管的临床资料,术中胆囊残端不闭锁缝合,分析术后胆漏发生率、持续时间、量及住院时间、胆囊管残留综合征(cholecystic duct remain syn-drome,CDRS)发生率、胆道损伤等。结果:术后发生胆漏5例(31.25%);胆漏持续时间2~5d,平均(3.4±1.1)d;24h最大胆漏量10~150ml,平均(58±57.6)ml;住院时间7~12d,平均(8.7±1.4)d,未发生CDRS及胆道损伤。16例患者均治愈出院。随访1~18个月未发现与手术有关的近远期并发症。结论:Calot三角解剖困难时残留部分胆囊壶腹或胆囊管的腹腔镜胆囊大部切除术,术中不闭锁缝合胆囊残端可以避免发生CDRS及误伤肝外胆管等,出现胆漏经过短期持续腹腔引流后可自愈。腹腔镜胆囊大部切除术不闭锁缝合胆囊残端是安全、可行、有效的手术方法。

Non-closure and suture gallbladder stump after the subtotal laparoscopic cholecystectomy

Objective:To explore the feasibility of non-closure and suture gallbladder stump after the subtotal laparoscopic cholecystectomy with residual gallbladder ampullae and cystic duct.Methods:The clinical data of 16 cases with difficult dissection of the Calot's triangle undergoing subtotal laparoscopic cholecystectomy without closure and suture gallbladder stump from May.2006 to Mar.2008 was analyzed retrospectively.Results:The subtotal laparoscopic cholecystectomy was completed in all 16 cases.Postoperative bile leakage occurred in 5 cases.The bile leakage time was 2-5d[mean,(3.4±1.1)d].The max amount of bile leakage in 24h was 10-150ml [mean,(58±57.6)ml].The hospitalization was 7-12d[mean,(8.7±1.4)d].There was no case of cholecystic duct remain syndrome(CDRS) and biliary tract damage.During a follow-up period for 1-18 months,there was no any delayed complication after operation.Conclusions:CDRS and damage of biliary tract can be avoided after non-closure and suture gallbladder stump in the subtotal laparoscopic cholecystectomy reserving gallbladder ampullae and cystic duct.Bile leakage can be cured after short-time prophylactic drainage.So non-closure and suture gallbladder stump after the subtotal laparoscopic cholecystectomy is safe and effective.