腹腔镜胆囊切除术中粗大胆囊管的处理

目的:探讨腹腔镜胆囊切除术(LC)中粗大胆囊管的处理方法.方法:1995-10/2004-12施行LC 640例,发现胆囊管明显增粗46例,其中胆囊管直径为0.4-0.6 cm.0.6-0.8 cm,0.8 cm以上的例数分别为21,14和11例.分别采用阶梯施夹法(12例)、大号钛夹法(5例)、圈套器法(1例)、结扎后再施夹法(22例)和结扎法(6例)处理增粗的胆囊管.结果:全组46例患者手术顺利,术后无胆漏及其他并发症发生.结论:在LC中,可选用阶梯施夹法、大号钛夹法、圈套器法、结扎后再施夹法和结扎法等牢固处理增粗的胆囊管.如果结扎技术熟练,结扎法可适用于各种情况,可做为首选.

Management of an enlarged cystic duct in laparoscopic cholecystectomy

AIM:To investigate the management of an enlarged cystic duct in laparoscopic cholecys- tectomy. METHODS:From November 1995 to December 2004,46 patients with enlarged cystic ducts un- derwent laparoscopic cholecystectomy in our hospital.The diameters of the cystic ducts were 0.4-0.6 cm in 21 cases,0.6-0.8 cm in 14,and>0.8 cm in 11.Five treatment methods were under- taken:overlapped clipping(n=12),large-sized titanium clipping(n=5),endoloop(n=1),clap- ping after ligation(n=22),and ligation(n=6). RESULTS:All patients were discharged from hospital without complications. CONCLUSION:Suitable methods need to be implemented to manage enlarged cystic ducts in laparoscopic cholecystectomy.A ligation method may be the first choice if the operator is skilled in ligation technology.