腹腔镜下胆囊切除术方法学探讨

目的探讨电视腹腔镜下胆囊切除术（laparoscopiccholecystectomy，LC）手术方法及推广应用的价值。方法（1）采用腹腔镜剥葡萄皮和切除离体动物胆囊方法，探索LC技巧并在临床进行应用；（2）对93502例胆系疾病患者术前进行胆系及周围相临器官仔细扫查，根据胆系结石发生部位和病灶的病理改变程度分为LC适应证组80492例和IC相对困难组13010例，观察胆囊大小、囊壁厚度、囊内结石或其他病灶大小、形态，回声特征及超声彩色多普勒信号，施行LC.结果适应证组8例中转开腹完成手术，Lc成功率99．99％（80484／80492），相对困难组中963例经中转开腹完成手术，LC成功率92．60％（12047／13010）；两组LC成功率比较，适应证组高于相对困难组，差异有统计学意义（P〈0．05）。术前超声诊断与手术病理结果符合93190例，符合率99．99％（93190／93502）。结论严格掌握手术适应证能减少LC中转开腹手术，对提高LC成功率有一定意义；术前基础训练，术中LC技巧的熟练应用，对缩短LC手术时间和避免术中、术后并发症及康复至关重要。

Methodology, popularization and application of laparoscopic cholecystectomy

Objective To study the operative method and applicability of laparoscopic cholecystectomy （LC）. Methods （ 1 ） The clinical application was explored by separating grape skin and cutting the gallbladder of animals ex vivo with laparoscope. （2） The biliary tract and adjacent organs of 93 502 cases were examined before operation, who were divided into two groups： LC indication and LC difficulty. The size of cholecyst, thickness of the eholecyst wall, concretion and other pathological changes were detected before operation according to resonance featurea and signals of CDFI. Results LC was successful among 80 484 of the 80 492 patients with LC indication. 8 cases were treated by open surgery, and the success rate of LC was 99.99% （80 484/80 492）. However, among the 13 010 patients with LC difficulty, 12 047 received successful LC. 963 cases underwent open surgery, the success rate of LC being 92.60% （12 047/13 010）. Comparing the two groups, we found that the success rate in LC indication group was higher than that in LC difficulty group ; the difference was significant （ P 〈 0.05 ）. Results of postoperative pathology were in good agreement with the preoperative ultrasonic diagnosis, and the coincidence rate was 99.99% （93 190/93 502）. Conclusions It is important to follow op- erative indications strictly, which could reduce the rate of open surgery and strengthen preoperative fundamental training. Furthermore, methodological skills of LC can help shorten surgery time and prevent postoperative complications, which is also important for the recovery of patients.