腹腔镜胆囊切除术911例治疗体会

目的回顾性分析911例腹腔镜胆囊切除术(LC),总结成功经验,以不断提高技术、扩展应用范围。方法严格选择适应证,实施腹腔镜胆囊切除术911例,均采用四孔法穿刺造气腹,遵循稳、准、轻和就高解剖的原则,充分解剖暴露胆囊三角区,确认"三管一壶腹"。结果成功898例,其中中转开腹13例,中转率为1.4%;出现并发症6例,包括胆漏2例,右侧气胸1例,术后腹腔出血1例,胆总管残石2例(术前1例),胆总管横断损伤1例。结论熟练的手术团队、丰富的肝胆外科开腹及腹腔镜手术操作经验、合适的围手术期处理以及必要的中转开腹是保证手术成功的关键,也是确保患者安全、减少并发症的重要手段。

Experiences in 911 Cases of Laparoscopic Cholecystectomy

Objective To analyze 911 cases of laparoseopic cholecysteetomy （ LC ） retrospectively and summarize the successful experiences so as to promote constantly the surgical technology and application scope. Methods 911 cases with strictly selected indications received LC with four - hole puncture to induce aeropertonia according to the principle of stability, accuracy, gentleness and high - level dissection to achieve adequate exposure of the triangular area of the gallbladder and identify for sure ＂the 3 ducts and 1 ampulla＂. Results 898 cases of them were successful,of which, 13 cases were conversed to open surgery, accounting for 1.4% ;6 cases had complications, of which,2 cases were bile leakage, 1 case had pneumothorax on the right side, 1 case had postoperative hemorrhage of the abdominal cavity,2 cases had residual stone in the common bile duct（ 1 case of them appeared before operation）and 1 case had traverse injury of the common bile duct. Conclusion The skillful surgical team, a wealth of the experiences in hepatobiliary open surgery and laparoscopic operation,appropriate perioperative management as well as the necessary conversion to open surgery are to ensure the success of operation and enable the safety of the patients and reduce the complications.