120例腹腔镜胆囊切除术中胆囊管及胆囊动脉的处理

目的　研究腹腔镜胆囊切除术 (laparoscopiccholecystectomy ,LC)中胆囊管和胆囊动脉的正常解剖及变异 ,旨在选用恰当的手术方法正确处理 ,提高LC手术的质量 ,减少并发症。方法　LC手术 12 0例 ,术前经过肝胆超声检查 ,口服加静脉胆管造影选择 ,排除肝外胆管结石病例 ,在气管插管全麻下 ,人工CO2 气腹 ,采用顺行或逆行法游离胆囊 ,认清“三管”的关系 ,安全钳夹后剪断胆囊管。提高对变异胆囊动脉的处理水平 ,可减少意外的紧急出血。结果　LC手术 12 0例 ,胆囊管变异 38例 ,胆囊动脉变异 2 1例 ,LC中转手术 9例 ,全组发生 1例胆总管损伤 ,4天后经开腹胆肠内引流治愈。结论　LC术中对异常胆囊管和胆囊动脉的认识和处理水平 ,对提高手术质量 ,减少并发症具有非常重要的意义。

Laparoscopic Cholecystectomy and Treatment of Cystic Duct and Artery

Objective By researching into the normal anatomy and variant of cystic duct and artery during laparoscopic cholecystectomy (LC) , to choose a proper survey method to ensure surgical quality and to lessen complications in LC . Method Among 120 LC cases, through preoperative ultrasonography of liver and gallbladder, oral ingestional and veinal cholecystography, some cases of extrahepatic bile duct caculous were excluded . Aided with artificial CO -2 pneumoperitioneum under tracheal intubation general anaesthesia , gallbladder was dissociated by anterograde or regression method . Then the cystic duct was held by forceps and cut after confirming the relationship of the "three-ducts". Improved technique to treat variant cystic artery may lessen accidental bleeding . Result Among 120 cases-38 cases of cystic duct variant, 21 cases of cystic artery variant, 9 cases of LC to Open Cholecystectomy (OC)-1 ductus-communis injury in LC was cured after it was enforced Roux-en-y Choledocho-jejunostomy 4 days later. Conclusion Improving the level of cognition and treating of cystic duct and cystic artery is very important to promoting operation quality and decreasing complications.