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目的探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中行胆囊壶腹入路预防胆道损伤的临床意义。方法 2008年7月至2011年3月北京军区总医院肝胆外科应用腹腔镜胆囊壶腹入路法行胆囊切除术537例,对其临床资料进行分析。结果以壶腹部与胆囊管移行区为解剖学标志,顺利显露胆囊壶腹部、胆囊管、胆总管及胆囊动脉,均成功进行了经腹腔镜胆囊切除手术,未发生血管及胆管损伤。结论在腹腔镜胆囊切除术中,采用壶腹入路法,胆囊壶腹部与胆囊管移行区是关键解剖学标志,该区域的完整、精准显露,是成功进行腹腔镜胆囊切除术的保证,可有效避免术中胆道损伤。

Clinical significance of cholecystic ampulla access during laparoscopic cholecystectomy:a summary of 537 cases

Objective To explore the value through the cholecystic ampulla access to the prevention of bile duct injury during laparoscopic cholecystectomy(LC).Methods The clinical data of 537 cases of LC through cholecystic ampulla access performed from July 2008 to March 2011 in General Hospital of Chinese PLA Beijing Military Region were analyzed.Results Based on the the cholecystic ampulla access and dissection transition zone of cholecystic ampulla and duct of gallbladder,the cholecystic ampulla,duct of gallbladder,the bile commen duct and the arteria cystica were revealed.All the cases were operated with LC successfully without injury of blood vessel and bile duct.Conclusion The transition zone of cholecystic ampulla and duct of gallbladder is the key landmark.Precise and integrity disposing is the guarantee of successful LC,which can optimize the critical view of safety,lower the chance of iatrogenic bile duct and blood vessel injury during LC.