腹腔镜胆囊次全切除术治疗复杂性胆石症

目的探讨腹腔镜胆囊次全切除术应用于复杂性胆石症治疗的可行性及优越性。方法将2004年1月～2008年12月收治的各类复杂性胆石症病变102例,随机分为腹腔镜胆囊次全切除术组(LSC组,47例)和腹腔镜胆囊切除术组(LC组,55例)。观察两组患者术中出血量、手术时间、腹腔镜胆囊切除术中转开腹胆囊切除情况、术后引流情况、胆囊窝积液和并发症等指标。结果LC组术中出血量和每天腹腔引流量均显著高于LSC组(P<0.01),而且LC组的手术时间、住院时间与LSC组比较差异也具有统计学意义(P<0.01)。LC组术后并发症及术后复查时胆囊窝积液发生率也高于LSC组,但比较无统计学意义(P>0.05)。结论腹腔镜胆囊次全切除术在治疗复杂性胆石症中,可降低手术风险,减少术后并发症的发生率和肝外胆道损伤的发生率,是治疗复杂性胆石症安全有效的手术方法。

Treatment of laparoscopic subtotal cholecystectomy for complicated cholelithiasis

Objective To explore the feasibility and superiority of laparoscopic subtotal cholecystectomy(LSC) in treatment of complicated cholelithiasis.Methods From January 2004 to December 2008 in our hospital,102 cases of complicated cholelithiasis patients were randomly divided into laparoscopic subtotal cholecystectomy(LSC) group(47 cases) and laparoscopic cholecystectomy(LC)group(55 cases).Blood loss volume,operative time,conversion of LC to open cholecystectomy(OC),drainage after operation,gallbladder fossa effusion and complications were compared between two groups.Results In LC group,blood loss,operative time and abdominal drainage volume were significantly increased as compared with those in LSC group.The incidence of postoperative complications and gallbladder fossa effusion rate in LC group was also higher than those in LSC group.Conclusion LSC can simplify surgical procedures and reduce operation risks,and also decrease the incidence of perioperative complications and the rate of extrahepatic bile duct injury and decline the conversion percentage of LC to open surgery.LSC is a safe and effective approach.