腹腔镜下复杂胆囊切除术78例手术技巧的探讨

目的 探讨腹腔镜下复杂胆囊切除术的手术技巧。方法 在全麻下对腹腔严重粘连，胆囊萎缩、胆囊扩张、解剖变异、术中活动性出血，结石掉入腹腔等复杂困难情况，行Calot三角精细解剖超常处理。结果 临床手术400例，其中复杂困难手术78例，中转开腹5例，胆汁瘘1例。结论 术中精细解剖Calot三角是腹腔镜下复杂困难胆囊切除术成功的关键，防止周围脏器的损伤是成功的基础。术中手下要能分辨出组织，手术技巧和手感是非常重要的。

Experiences in Difficult Laparoscopic Cholecystectomy in 78 Cases

Objective To study the skills of laparoscopy for difficult cholecystectomy.Methods Under general anesthesia, cases with abdominal cavity serious abhesion, gall bladder atrophy, gall bladder expansion, anatomy variation, active bleeding in the operation, stones dropping into abdominal cavity were operated by Calot triangle fine anatomy.Results In 78 cases, 5 cases were converted to open surgery, 1 case had bile leakage. Conclusion Fine anatomy of Calot triangle is the key to the successful operation for difficult and complex laparoscopic cholecystectomy with the prevention of the damage of nearby organs.