腹腔镜胆囊切除困难与对策

急性与慢性胆囊炎导致腹腔镜胆囊切除的困难因素有多种,应采取个体化的处理策略才能顺利完成手术。灵活运用胆囊体造洞抓持技术、纵切法超细纤维胆管镜探查辨识胆囊管与胆总管、胆囊翻转技术、胆囊大部切除技术、胆囊逆行或顺逆结合切除技术、胆囊穿刺与劈开技术、胆囊黏膜下剥离技术、压迫止血法以及置管引流等,有助于实现"无开腹胆囊切除术"。

Surgical techniques and difficulties of laparoscopic cholecystectomy

There are various difficult operative factors of laparoscopic cholecystectomy in treating acute and chronic cholecystitis .We should adopt individualized surgical techniques to complete the operation successfully .Methods including the gallbladder body made the hones for grasping , longitudinal cutting method to identify cystic duct and common bile duct via superfine fiber choledochoscope , gallbladder retroflexed technique, subtotal laparoscopic cholecystectomy , retrograde cholecystectomy or combined antegrade and retrograde cholecystectomy , the gallbladder punctured or/and cleave approach , sub-mucosal dissection , oppression hemostasis, rubber tube drainage and so on, can all help to avoid open cholecystectomy.