三孔技术在急性胆囊炎腹腔镜胆囊切除术中的应用

目的：探讨三孔技术腹腔镜胆囊切除在急性胆囊炎的应用条件及价值。方法：采用三孔技术行LC共2917例，其中用三孔技术施行急性胆囊炎97例。结果：三孔技术法完成85例，因粘连及充血性水肿严重，转四孔法10例(其中行胆囊大部切除2例)，因Cdot三角区冰冻性粘连，中转开腹2例，三孔法完成的85例中行胆囊大部切除1例。全组治愈，元胆管损伤、胆瘘及出血等并发症发生。结论：三孔法LC与四孔法LC相比创伤更小，但在急性胆囊炎行LC时，操作难度加大，特别是Calot三角区的解剖及显露对术者手术技巧要求高。

Application of Three- port Technique for Laparoscopic Cholecystectomy in Acute Cholecystitis

Objective: To evaluate the role and condition of three-port technique for laparoscopic cholecystectomy (LC) in acute cholecystitis. Methods: From May 1994 to Oct 2002, 2?917 cases underwent LC with technique of three-port, of which 97 cases were acute cholecystitis. The role and condition of technique were retrospectively analyzed. Results: Three-port LC was successfully carried out in 85 cases. Related to adhensive or severe inflammation, 10 were converted to four-port LC, of which 2 underwent laparoscopic subtotal cholecystectomy. 2 cases were converted to open procedure because of icy adherence in the Calot triangle. Among 85 cases undergoing three-port LC, one patient subjected to laparoscopic subtotal cholecystectomy. All patients recovered uneventfully. No bile duct injury, bile leakage or postoperative hemorrhage was noted. Conclusion: Compared with four-port LC, less invasion was observed in patients undergoing three-port LC. Three-port LC during acute cholecystitis, however, was more difficult. Especially, dissection and exposure of the Calot triangle technically demanded much experience of the performer. Thus, some condition should be met in application of three-port technique for acute cholecystitis.