高原地区腹腔镜治疗结石性胆囊炎的诊疗体会

目的总结高原地区腹腔镜治疗结石性胆囊炎的临床经验,提高围手术期的安全性。方法回顾性分析2015年1月至2016年6月60例行腹腔镜下胆囊切除术患者的临床资料。结果本组60例患者术中探查胆囊周围严重粘连、三角区解剖不清32例,结石位于胆囊壶腹部或胆囊管结石嵌顿11例,急性化脓性胆囊炎伴胆囊结石13例。顺利实施腹腔镜下胆囊切除52例,中转开腹8例,中转开放率13.3%。平均手术时间56 min(40~115 min),无严重并发症与死亡病例。结论高原地区结石性胆囊炎病程长,手术野炎症粘连重,解剖结构不清,中转开放率相对较高,并发症多。积极完善术前准备,充分评估手术风险,术中仔细操作等均是保障围手术期安全的关键。

Clinical experience in the laparoscopic treatment for the patients with calculous cholecystitis in plateau region

Objective To summarize our experience in the laparoscopic treatment on the plateau region patients with calculous cholecystitis for improving the perioperative safety.Methods Clinical data of 60 cases of patients underwent laparoscopic cholecystectomy were restrospective1y reviewed during January 2015 to June 2016.Results The 60 patients included 32 cases with severe adhesion around gallbladder,11 cases with gallbladder ampulla and cystic duct stone incarceration.13 cases with acute gangrenous cholecystitis with gallbladder stones.There were 52 cases with successful implementation of the laparoseopic cholecystectomy,and 8 cases were convened to open cholecystectomy.The conversion rate was 13.3％.Mean operative time was 56 min(range,40 to115 min).There were no cases with serious complications or even deaths during the properative period.Conclusion There are lots of characteristic in patients with laparoscopic cholecystectomy in high altitude area,such as long course of disease,severe adhesion around gallbladderd and unsharp anatomical structure.It is a complicated surgical treatment with comparatively high conversion rate and manyz complications.Completely preoperative inspect,sufficient preparation and carefully operation are the key points to safety during the peroperative period.