腹腔镜胆囊部分切除术在复杂胆囊结石手术中的应用

目的：探讨腹腔镜胆囊大部分切除在复杂胆囊结石手术中应用的可行性及安全性。方法：回顾性分析2003年1月至2008年10月间41例行腹腔镜胆囊部分切除术的复杂胆囊结石病人。行腹腔镜胆囊切除术指征为：胆囊管不能明确辨认时,诸如：胆囊积脓、Mirris综合征、Calot三角致密粘连呈＂冰冻样＂、萎缩性胆囊等。手术方法为：切除胆囊前壁,取净结石,腹腔置管引流。结果：41例复杂胆囊结石病人中1例中转开腹手术外,其余全部在腹腔镜下完成,手术时间为45～145分钟,平均（57.42±19.41）分钟,1例术后出现胆漏,其余术后住院时间为2～7天。结论：在胆囊三角不能安全辨认前提下,对于复杂胆囊结石行腹腔镜胆囊部分切除术是一种安全的手术方式,不但能简化手术、降低手术风险,而且能避免行开腹手术治疗。

The Use of Laparoscopic Subtotal Cholecystectomy for Complicated Cholelithiasis

Objective：To study the possibility and safty of laparoscopic subtotal cholecystectomy in complicated cholecystectomy.Methods：Laparoscopic subtotal cholecystectomy was performed when the cystic duct cannot be identified safely,such as empyema cholecystitis,Mirris syndrome,frozen Calot＇s triangle,shrunken gallbladder.The operation consists of resecting the anterior wall of the gallbladder,removing all stones,and placing a large drain.41 patients who underwent a laparoscopic subtotal cholecystectomy between 1 January 2003 and 31 October 2008 were retrospectively analyzed.Results：Forty-one cases of complex laparoscopic cholecystectomy were performed.1 cases in which were changed to open cholecystectomy.Operating time was 45-145 min,average（57.42±19.41） min.1 cases were reoperated because of the bile leak.Hospital stays were 2-7 days.Conclusion：Laparoscopic subtotal cholecystectomy is a viable procedure during cholecystectomy in which Calot＇s triangle cannot be safely dissected.It may simplify the operation and decrease the risk in complicated cholecystectomy and averts the need for a laparotomy.