胆囊颈管结石嵌顿患者行腹腔镜胆囊切除术的体会

目的:探讨胆囊颈管结石嵌顿合并急、慢性胆囊炎的患者行腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的特点及注意事项。方法:回顾分析78例胆囊颈管结石嵌顿伴急、慢性胆囊炎、胆囊积液患者行LC的临床资料。结果:76例顺利完成LC,其中3例为Mirizzi综合征Ⅰ型;1例因合并胆囊结肠漏、胆囊右肝管漏中转开腹,另1例为Mirizzi综合征Ⅱ型,术中胆总管损伤中转手术行胆总管对端吻合"T"管支撑引流术。结论:腹腔镜手术治疗胆囊颈管结石嵌顿患者(包括Mirizzi综合征Ⅰ型)是安全可行的,术中对解剖困难或合并胆囊与邻近脏器内瘘的形成以及Mirizzi综合征Ⅱ型以上等应及时采取开腹手术。

Experience of laparoscopic cholecystectomy in neck and duct of gallbladder calculus

Objective:To explore the characteristics and notices of laparoscopic cholecystectomy(LC) to patients with calculus in neck and duct of gallbladder combined with acute or chronic cholecystitis.Methods:The clinical data of LC to 78 cases with calculus in neck and duct of gallbladder combined with acute chronic cholecystitis and hydrops of gallbladder were analysed retrospectively.Results:Seventy-six cases were successfully performed LC,three cases were Mirizzi syndrome type Ⅰ,and one case was converted to open surgery because of gallbladder-colon fistula and gallbladder-right hepatic duct fistula,and one was converted to choledocholithotomy with T-tube drainage because of Mirizzi syndrome(type Ⅱ) combined with injury of common bile duct.Conclusions:LC is suitable and safe for patients with calculus in neck and duct of gallbladder(including Mirizzi syndrome,type Ⅰ).Open surgery should be advocated when there is difficulty in anatomy or fistula formation between gallbladder and organ nearby,or Mirizzi syndrome(type Ⅱ or above) happens.