急性结石性胆囊炎腹腔镜手术252例

目的:探讨急性结石性胆囊炎腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的手术操作要点．方法:回顾性分析本院1995-10／2005-10收治的252例胆囊结石并急性胆囊炎LC病例．结果:应用熟练的镜下操作技术,仔细解剖 Calot三角、近胆囊断离胆囊动脉、恰当处理术中出血、灵活应用电凝止血与钛夹止血相结合,顺利完成腹腔镜胆囊切除术244例,中转开腹胆囊切除术8例,系因合并胆囊癌、十二指肠球部巨大溃疡、Mirizzi综合征、胆囊壶腹部与胆总管粘连严重、胆囊十二指肠致密粘连及内瘘形成等原因而中转开腹,无术中大出血、肝外胆管损伤而中转开腹的病例．无术后胆漏、腹腔内出血等严重并发症发生．近期随访无胆管狭窄并发症发生．结论:急性胆囊炎行LC安全可行,关键是术者必须充分了解LC操作要点和熟练掌握操作技术．

Laparoscopic cholecystectomy for acute calculous cholecystitis: an analysis of 252 cases

AIM: To investigate the key points of laparoscopic cholecystectomy (LC) in the treatment of acute calculous cholecystitis. METHODS: The data of 252 patients with acute calculous cholecystitis admitted in our hospital from October 1995 to October 2005 were retrospectively analyzed. RESULTS: After carefully dissecting Calot triangle,separating and cutting off the cystic artery near gallbladder, and stopping bleeding using electrocoagulation combined with titanium clamps, 244 patients were successfully cured by LC. Meanwhile, 8 cases were shifted from LC into open cholecystectomy due to gallbladder cancer, immense ulcer on the globe part of duodenum, Mirizzi syndrome, the serious conglutination of bile duct and the ampulla part of gallbladder, the closed conglutination between duodenum and gallbladder, and the formation of inner fistula other than the reasons of haem- orrhage and bile duct injuries outside the liver. Complications such as biliary leakage or haemorrhage in abdominal cavity were not detected after the operation. No postoperative biliary stricture occurred in the recent following up. CONCLUSION: Laparoscopic cholecystectomy is safe and feasible in the treatment of acute calculous cholecystitis,and successful surgery should be based on the skilled techniques and the knowledge of key points in the operation.