腹腔镜胆囊切除术细化手术方式的临床研究

目的探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）三种改进方法的临床特点和应用效果。方法对我院1992—2006年64257例Lc应用方法和效果进行回顾性分析，61212例采用冲洗器辅助显露的对抗牵引技术；2619例采用保留并缝合胆囊颈部后壁的颈部横断技术；426例采用“锁边”夹闭危险区胆囊壁的锁边技术。结果对抗牵引组61212例，死亡7例（0．01％），中转开腹345例（0．56％），胆管损伤51例（0．08％），胆漏61例（0．10％），通向胆囊的异常管道458例（0．75％）。颈部横断组2619例，中转开腹76例（2、90％），胆漏24例（0．92％）。锁边组426例，中转开腹32例（7．51％），胆漏11例（2．58％）。结论各种方法都有各自的特点和适应证，对抗牵引技术适用于不复杂胆囊情况，颈部横断技术和锁边技术适用于复杂炎症、粘连情况。

A Clinical Study on Modified Laparoscopic Cholecystectomy

Objective To explore clinical indication and effects of three modified procedures of laparoscopic cholecystectomy(LC).Methods From 1992 to 2006,LC procedures and effects of 64 257 cases were retrospectively analyzed.61 212 cases were treated by irrigator-assisted counter-traction technique to expose gallbladder and duct.2691 cases were conducted by transecting neck of gallbladder,suturing posterior wall of neck of gallbladder.426 cases were performed by titanic-clamp hemstitch suture technique,which occluded the risk region-gallbladder wall using clamp hemstitch.Results In the Counter-traction Group consisting of 61 212 cases,7 cases(0.01%) died,345 cases(0.56%)were converted to open surgery,51 cases(0.08%) had biliary duct injury,61 cases(0.10%)had bile leakage,458 cases(0.75%) had abnormal ducts toward to gallbladder.In the Neck Transaction Group consisting of 2619 cases,76 cases(2.90%) were converted to open surgery,24 patients(0.92%) experienced bile leakage.In the Hemstitch Group composed of 426 cases,32 cases(7.51%) were converted to open surgery,11 cases(2.58%) had bile leakage.Conclusions Different procedures have respective characters and indications,contrast-traction technique is adapted to no complicated gallbladder,while neck transaction technique and hemstitch suture technique are suitable for complicated inflammations and adherence of gallbladder.