腹腔镜胆囊切除术的难度分级探讨

目的:探讨腹腔镜胆囊切除术(LC)手术的难度分级方法及原因。方法:回顾分析1 983例经腹腔镜胆囊切除术难度分级标准(laparoscop ic cholecystectomy d ifficu lty c lassification,LCDC)评定的LC手术。结果:DC I有1 374例,DC II有470例,DC III有139例;LC最常见的困难是剥离胆囊,而最难处理的是胆囊管及胆囊三角;LCDC难度低的一般是慢性结石性胆囊炎,较难的是急性胆囊炎和慢性萎缩性胆囊炎,很难的是合并有胆囊颈、管部结石嵌顿和/或解剖变异的急性胆囊炎和慢性萎缩性胆囊炎。结论:LCDC可细化LC手术难度原因,对LC有积极意义。

Exploration of the difficulty classification in laparoscopic cholecystectomy

Objective:To explore the methods and reasons of the difficulty classification in laparoscopic cholecystectomy(LC).Methods:The clinical data of 1 983 patients assessed with laparoscopic cholecystectomy difficulty classification(LCDC) were retrospectively studied.Results:According to LCDC,1 374 cases were classified to DCI,470 cases to DCII,and 139 cases to DCIII.The most common difficulty was dissection of cholecyst,while the most difficult procedure was dealing with the cystic duct and Calot's triangle.LC in patients with acute and chronic atrophic cholecystitis was more difficult than in those with chronic calculous cholecystitis,but still easier than in those incorporated with calculus incarceration in neck of gallbladder or cyst duct,or with anatomical anomaly.Conclusions:LCDC can evaluate the difficulty of LC,and thus will play an important role in LC.