腹腔镜胆囊切除术治疗急性胆囊炎（附238例报告）

目的探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）治疗急性胆囊炎及慢性胆囊炎急性发作的疗效。方法2003年5月-2007年11月对238例急性胆囊炎及慢性胆囊炎急性发作施行四孔法LC,腹腔内压力控制在11-13mm Hg,对一些年老体弱的患者,气腹压力控制在10mm Hg。若术中探查发现胆囊三角水肿明显,解剖困难,则逆行切除胆囊;若术中发现胆囊管内结石嵌顿,则尽量将结石挤入胆囊后切除胆囊,为防止胆囊管内结石进入胆总管,术中经胆囊管行胆道造影,除外胆管结石。结果220例LC成功;18例中转开腹：术中出血及解剖困难12例,术中发现胆管结石6例。2例术后出血,经二次手术止血后康复出院。6例术后2-4d发生胆漏,引流量较少,每天50-80ml,采取保守治疗（禁食,静脉补液和静脉用抗生素）后治愈。238例术后随访1-12个月,平均6个月,未出现术后并发症。结论LC治疗急性胆囊炎或慢性胆囊炎急性发作可行且有效,但应选择恰当的手术时机,解剖胆囊三角显露胆囊管是手术的关键,当腹腔镜手术遇困难时,应适时中转开腹手术。

Laparoscopic Cholecystectomy for Acute Cholecystitis: Report of 238 Cases

Objective To investigate the efficacy of laparoscopic cholecystectomy（LC）for patients with acute cholecystitis.Methods From May 2003 to November 2007,238 patients with acute cholecystitis underwent LC in our hospital.Four trocars were used in the operation.During the procedure,intraperitoneal pressure was controlled at 11 to 13 mm Hg（10 mm Hg for elderly patients）.Retrograde cholecystectomy was performed on the patients with difficult anatomy caused by edema of the cystic triangle.For cases with calculi incarcerated in the cystic duct,the LC was performed after the stones were removed into the cyst（cholangiography was performed to exclude bile duct calculi）.Results Of the 238 cases,LC was completed successfully in 220 patients,the other 18 cases were converted into open surgery because of massive hemorrhage and difficult anatomy（12 cases）or bile duct calculi（6 cases）.After the LC,two patients received a second surgery because of postoperative hemorrhage;six patients developed bile leakage（occurred at 2-4 days after the LC with 50-80 ml of drainage）and were cured by conservative therapy including fasting,intravenous nutrition and anti-biotic therapy.This series were followed up for 1 to 12 months（mean,6 months）.No post-operative complications were noticed during the period.Conclusions LC is a safe and effective for patients with acute cholecystitis or acute episode of chronic cholecystitis.Controlling the operation opportunity properly and dissecting the Calot＇s triangle area carefully to expose the cystic duct are the key steps during the operation.Convertion to open surgery is necessary in some difficult situations.