急诊腹腔镜治疗胆囊颈管结石嵌顿85例分析

目的：总结急诊腹腔镜治疗胆囊颈管结石嵌顿的经验。方法：2005年1月—2010年5月对急性胆囊炎胆囊颈管结石嵌顿85例采用四孔法和钝性解剖及吸引器管吸、推法行腹腔镜胆囊切除术（LC）。结果：81例顺利完成LC,4例中转开腹,其中1例胆囊颈部结石大,明显影响术野,无法解剖胆囊三角;1例为Mirizzi综合征;2例为胆囊三角炎性粘连呈冰冻状无从下手,术后2例胆瘘,1例出血。85例均痊愈出院。结论：急诊腹腔镜治疗胆囊颈管结石嵌顿是安全可行的,但要掌握好手术时机。

Clinical analysis of 85 cases cholecystitis with gallstone incarcerated treated by emergency laparoscope

Objective：To investigate the experience of laparoscopy operation with stone incarceration in neck of gallbladder.Methods：From January 2005 to May 2010,a total of 85 consecutive patients of acute cholecystitis with stone incarceration in neck of gallbladder undergoing operation were retrospectively analyzed.All the patients received four-trocar technique,blunt dissection.Results：Eighty-one cases had laparoscopic cholecystectomy successfully without serious complication,4 cases were converted to open cholecystectomy,2 cases because the stone larger,can not dissect the triangle of gallbladder,2 cases of inflammatory adhesion of gallbladder were frozen triangular shape can not operation.1 case Mirizzi syndrome.2 cases combined with postoperative biliary fistula,1 case of postoperative hemorrhage,85 cases were recovered and discharged from hospital.Conclusion：Emergency laparoscopic treatment of incarcerated stones in the gallbladder neck is safe and feasible,but to master the timing of surgery.