腹腔镜胆囊切除术适应证的探讨

目的　探讨不加选择的情况下腹腔镜胆囊切除术的适应证及临床疗效。　方法　总结 1998年～ 2 0 0 1年 8月未加选择连续实施的 2 4 3例腹腔镜胆囊切除术 ,分析其中转开腹率和手术疗效。　结果　全组 2 4 3例LC病人中共有 3例分别因胆囊床出血、胆管损伤、十二指肠与胆囊致密粘连胆囊三角解剖不清而中转开腹手术 ,中转开腹率为 1.2 %。术中并发症发生率为 1.2 % (3 2 4 3) ,术后并发症发生率为 0 .8% (2 2 4 3) ,总的手术并发症发生率为 2 .1% (5 2 4 3)。　结论　腹腔镜胆囊切除术对于规范化培训过的腹腔镜医师而言即使是急性期和萎缩性胆囊炎病人 ,也可在不明显增加手术并发症和中转开腹率的情况下安全地实施 ,所以LC适应证可以拓宽至 98%以上的有症状胆囊疾病患者。

A study on the Indication of laparoscopic cholecystectomy

Objective To investigate the indication of non-selective laparoscopic cholecystectomy(LC). Methods 243 cases of non-selective LC were reviewed retrospectively from 1998 to Auguest 2001. Results Among the 243 cases of LC, three cases were converted into open surgery with a conversion rate of 1.2% due to dense adhesion in Calot's triangle, bile duct injury and active bleeding in gallbladder bed. The surgical morbidity was 2.1%, 3 of them occurred during the laparoscopic cholecystectomy, and 2 of them occurred after operation. Conclusions Laparoscopic cholecystectomy in nonselective patients with symptomatic gallbladder diseases even with acute and/or atrophic cholecystitis can be performed safely and effectively with no increase of surgical morbidity and conversion rate for the well-trained laparoscopist, therefore the indication for LC can be extended to 98% patients with symptomatic gallbladder diseases.