腹腔镜胆囊切除术联合巨大肝囊肿手术35例报告

目的探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)联合巨大肝囊肿开窗引流、大网膜填塞固定术的临床应用价值及技术要点。方法对攀钢集团总医院密地院区2005年1月至2016年6月行LC联合巨大肝囊肿开窗引流、大网膜填塞固定术35例病人的临床资料进行回顾性分析。结果本组35例,34例完全在腹腔镜下完成了LC联合巨大肝囊肿开窗引流、大网膜填塞固定手术。1例术中发现囊液为较浓的胆汁,考虑可能与肝内较大的胆管相通,从而中转开腹手术行囊肿空肠Roux-en-Y吻合术。34例均放置残留囊腔引流管;28例同时放置腹腔引流管,于术后5~15 d无引出物后拔除。所有病人术后均恢复良好,无腹水、胆漏、腹腔内手术部位感染、囊肿复发等近远期并发症的发生。术后囊壁病理检查均报告为先天性肝囊肿。术后随访12~24个月,平均(18.20±3.60)个月,所有病人均恢复正常的生活和工作。结论在腹腔镜下行LC联合巨大肝囊肿开窗引流、大网膜填塞固定术是一种安全、可行、有效的手术方法。术中进行必要的腹腔冲洗、肝囊肿性质的准确判断、正确地选择手术方式、规范的手术操作等均是保证手术成功的重要因素。

Laparoscopic cholecystectomy combined with huge hepatic cyst surgery: a report of 35 cases

Objective To discuss laparoscopic cholecystectomy (LC) combined with huge hepatic cysts window drainage,Omentum to fill the clinical application value and main technical points of fixation.Methods At MIDI campus of pangang group general hospital between January 2005 and June 2016 laparoscopic cholecystectomy combined huge liver cyst window drainage,Omentum tamping fixation the clinical data of 35 patients were retrospectively analyzed.Results This group of 35 cases,34 cases fully completed LC joint cavity in huge hepatic cysts,Omentum fixed window drainage surgery,Found in 1 case of intraoperative fluid for thicker bile,considering possible with larger intrahepatic bile ducts are interlinked,line to transfer laparotomy cyst-jejunum Roux-en-Y anastomosis.34 cases were placed residual cystic cavity drainage tube,28 cases of abdominal cavity drainage tube is placed at the same time,Are in 5~15 d,no pull out after the eduction,All patients were recovered well postoperatively,No complications occurred such as ascites,bile leakage and intra-abdominal surgical site infection,cyst recurrence,immediate and long-term complications.Capsule wall postoperative pathologic examination were reported as congenital hepatic cysts.Postoperative follow-up of 12~24 months,average (18.20+3.60) months,All patients were back to normal life and work.Conclusions In laparoscopic downward"LC combined huge hepatic cysts window drainage,Omentum tamping fixation"is a safe,feasible and effective surgical method.Intraoperative necessary abdominal cavity flushing,the nature of the liver cyst,accurate judgment,correctly choose operation method,standard operation and so on all is the guarantee of the important factors of the success of the surgery.