腹腔镜胆囊切除术

Trocar采用“四孔法”布局。体位采用仰卧位,穿刺后头高足低30°,向左倾斜10°~15°。探查完毕后,可见胆囊大小约9 cm×3 cm×3 cm,与周围组织无粘连。助手无创钳下压网膜,术者左手提起胆囊,右手分离胆囊三角,钝性游离胆囊颈管和胆囊动脉,可见胆囊颈管直径约0.2 cm,胆总管直径约0.7 cm,肝右动脉发出胆囊动脉前后支。可吸收夹夹闭胆囊颈管及胆囊动脉,并切断,将胆囊从胆囊床剥离。自剑突下Trocar孔取出胆囊。电烙胆囊床,确认无活动性渗血后清点纱布、撤出腔镜器械。

Laparscopic cholecystectomy

Trocars were placed according to the“four-port”approach.The patient was secured in a supine position and then an anti-Trendelenburg(30°)and a right upper position(10°~15°)after trocar placement.After exploration,the size of the gallbladder was about 9 mm×3 mm×3 cm,and there was no adhesion with the surrounding tissues.The chief surgeon lifted the ampulla of gallbladder and bluntly dissected the Calot’s triangle that involved the cystic duct and cystic artery while the first assistant was pressing the greater omentum with harmonic forceps.The diameter of the cystic duct and common bile duct was 0.2 cm and 0.7 cm,respectively,and the right hepatic artery gave rise to the anterior and posterior branches of the cystic artery.The cystic duct and artery were transected by absorbable clips.The gallbladder was separated from the liver and removed from the subxiphoid trocar site.Then,the gallbladder bed was cauterized and examined to avoid active bleeding.Finally,surgical gauze was checked,and all laparoscopic instruments were removed.