腹腔镜胆囊切除术1475例胆囊动脉胆囊管的解剖与处理

目的:报告腹腔镜胆囊切除术中胆囊动脉及胆囊管的解剖观察。方法:1991—1993年行腹腔镜胆囊切除术1475例,手术认真解剖了胆囊动脉和并用钛夹分别进行钳闭处理。结果:84.9％为主干型胆囊动脉,15.1％为多支型胆囊动脉、胆囊动脉缺如或细小,肝迷走胆囊动脉等变异。90.9％的胆囊管直径0.3—0.4cm,长1—3.5cm。因胆囊炎症的严重程度导致胆囊管纤维化闭锁或增粗多见。短胆囊管76例。因误认致肝外胆管横断伤3例,胆囊动脉后支出血止血钳闭部分肝总管1例,胆囊管残端瘘1例,变异胆囊动脉术后出血2例。术后并发心律失常、肺部感染,21d死于多器官功能衰竭1例(0.1％)。治愈1474例(99.9％)。结论:腹腔镜胆囊切除术治疗胆石症是-安全的方法,术中仔细解剖胆囊动脉和胆囊管极为重要。

Anatomy and management of cystic artery and duct in 1475 laparoscopic cholecystectomies

AIM To report the anatomic observation and management of the cystic artery and duct during laparoscopic cholecystectomies.METHODS From 1991 to 1993,1475 laparoscopic cholecystectomies were performed,and the anatomy and management of the cystic artery and duct were analyzed.RESULTS The main-trunk cystic artery accounted for 84.9%,and multiple-trunk,tiny or absence of cyclic artery,and aberrant cystic artery from the hepatic artery constituted 15.1%,90.9% of the cystic ducts were 0.3 cm-0.4 cm in diameter and 1 cm-1.3 cm in length.Fibrotic atresia and diltation of the cystic duct resulted from inflammation of the gallbladder were commonly observed.In 3 of 76 cases of the short cystic ducts,extra-hepatic bile ducts were transversely cut because of misjudgement.The common hepatic duct was partialy clipped in one patient during hemostasis for bleeding from the posterior branch of the cystic artery.Bile leakage from the cystic duct remmant occurred in one,postoperative hemorrhage from the aberrant cystic artery,Bile leakahe from the cystic duct remnant occurred in one,Postoperative hemorrhage from the aberrant cystic artery in two respectively.One patient died of cardiac arrhythmia,pneuomonia,and multiple organ failure on the 21th postoperative day,and 1474 patients were cured with a cure rate of 99.9%.CONCLUSTION Laparoscopic cholecystectomy is successful in cholelothiasis,and the anatomic observation and management of cystic artery and duct are essential during the operation.