腹腔镜治疗急性坏疽性胆囊炎临床分析

【目的】探讨腹腔镜胆囊切除术治疗急性坏疽性胆囊炎的安全性及可行性。【方法】回顾性分析54例腹腔镜胆囊切除术治疗急性坏疽性胆囊炎的临床资料。【结果】术前全部行彩色多普勒MRCP检查,其中50例行腹腔镜胆囊切除术,4例主动中转开腹手术,6例因胆总管结石术前行ERCP术,逆行法胆囊切除术34例,全部行胆囊窝引流,无1例被动中转开腹,术后2例出现不同程度胆瘘,5天后出院。【结论】腹腔镜胆囊切除术治疗急性坏疽性胆囊炎是一种切实可行的治疗方法。术前正确评估手术难度、逆行胆囊切除、主动中转开腹和精细的手术操作是治疗过程中安全有效的措施。

Clinical analysis on the treatment of acute gangrenous cholecystitis by laparoscopic cholecystectomy

【Objective】To explore the safety and feasibility of laparoscopic cholecystectomy in the treatment of acute gangrenous cholecystitis.【Methods】The clinical data of 54 cases of acute gangrenous cholecystitis treated by laparoscopic cholecystectomy were analyzed retrospectively.All cases were examined by Doppler ultrasound and MRCP before operation.【Result】Among the cases,50 cases were performed succeededly by laparoscopic cholecystectomy,4 cases were converted to open surgey actively,6 cases with common bile duct stones were treated by ERCP before operation,34 cases by retrograde cholecystectomy,drainage tube was placed in the fossa of gallbladder in all cases,no one converted to laparotomy during operation,2 cases with biliary fistula were fully recovered and discharged after 5 days.【Conclusion】Laparoscopic cholecystectomy is feasible and safe for acute gangrenous cholecystitis,proper evaluate the difficulty before surgery,retrograde cholecystectomy,active conversion to laparotomy and careful operation is the effective and safe method in the treatment of acute gangrenous cholecystitis.