急诊腹腔镜治疗重症急性胆囊炎临床分析

目的：探讨腹腔镜胆总管切开取石T管引流术治疗重症急性胆囊炎（ACST）的临床疗效。方法：收集2004年4月～2007年10月收治的80例重症急性胆管炎患者，运用腹腔镜胆总管切开取石T管引流术进行急诊手术治疗。结果：重症急性胆囊炎80例，76例成功实施LC，其中，胆囊穿刺减压＋胆总管切开取石T管引流11例，胆总管切开取石T管引流15例．胆囊造瘘＋胆总管切开取石T管引流14例，胆囊切除＋胆总管切开取石T管引流36例，手术时间15～120min．术中出血10～85ml；4例中转开腹，其中，1例胆囊与周围组织粘连严重，壶腹部标志消失，与肝十二指肠韧带界限不清，2例胆囊萎缩深陷肝脏内，胆囊三角区瘢痕粘连，1例胆囊管结石嵌顿且严重粘连，术后住院时间8-11d，术后恢复均良好，治愈出院；80例术后病理诊断，急性单纯性胆囊炎41例（51．2％），急性化脓性胆囊炎24例（30．0％），急性坏疽性胆囊炎15例（18．8％）。结论：经腹腔镜胆总管切开取石T管引流术急诊治疗重症急性胆管炎是可行、有效和安全的治疗方法。

Clinical analysis of emergency laparoscopic treatment for acute cholangitis of severe type

Objective： To evaluate the clinical efficacy of laparoscopic choledocholithotomy with T-tube drainage acute eholangitis of severe type （ACST）. Methods： 80 cases of ACST from April 2004 to October 2007 were selected and performed emergency laparoscopic treatment. Results： Among 80 cases of ACST, 76 cases were successfully implemented LC, gallbladder puncture and decompression ＋choledocholithotomy T-tube drainage were performed in 11 cases, choledocholithotomy T-tube drainage in 15 cases, common bile duct＋gall bladder fistula Toishi T-tube drainage in 14 cases, gallbladder removal＋choledocholithotomy T-tube drainage in 36 cases, operative time 15-120 min, bleeding 10-80 ml; 4 cases transitted laparotomy, 1 case of gallbladder and surrounding tissue adhesion serious, ampulla signs disappear, and the hepatoduodenal ligament ill-defined, 2 cases of gallbladder contraction deep within the liver, gallbladder triangle scar adhesions, and 1 case of duct stone impaction and severe adhesions; postoperative hospital stay was 8-11 d, all were well recovered; pathological diagnosis, acute eholecystitis in 41 cases （51.2%）, acute suppurative cholecystitis in 24 cases （30.0%）, acute gangrenous cholecystitis in 15 cases （18.8%）. Conclusion： Laparoscopie choledocholithotomy with T-tube drainage is a feasible, effective and safe treatment for patients with ACST.