刮吸切割法在腹腔镜胆囊切除术治疗急性胆囊炎中的应用体会

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗急性胆囊炎的手术方法及刮吸切割法在术中的应用价值。方法:回顾分析2007年11月至2013年10月为64例急性胆囊炎患者行LC的临床资料,术中采用吸引器刮吸分离与超声刀切割相结合的方法完成操作。结果:62例(96.9%)手术获得成功,1例因术中出血、1例因术前怀疑Mirizzi综合征中转开腹。手术时间平均(127±31)min,术中出血量平均(115±34)ml,术后下床活动时间平均(17.2±3.8)h,术后胃肠功能恢复时间平均(23.5±8.2)h,手术后胆漏2例(3.2%),术中放置引流管引流46例(74.2%),引流时间平均(4.7±2.3)d,术后平均住院(6.6±2.3)d。术后平均随访(8.2±2.5)个月,无黄疸、膈下感染、"小胆囊"、肝外胆管狭窄等并发症发生。结论:刮吸切割法应用于急性胆囊炎LC术中是安全、可行的。手术成功的关键是术前对病情进行充分讨论与评估,术中使用吸引器刮吸分离与超声刀切割相结合的方法,可较好地解剖Calot三角,有效避免术中大出血、胆管损伤,降低术中并发症发生率及中转开腹率。

The application of curettage,aspiration and dissection technique in laparoscopic cholecystectomy for acute cholecystitis

Objective：To explore the methods and the value of curettage, aspiration and dissection technique in treating acute eholeeystitis with laparoscopie eholeeysteetomy （LC）. Methods： A retrospective analysis was made on the clinical data 64 patients with acute eholecystitis who underwent LC from Nov. 2007 to Oct. 2013. Suction apparatus was used to scrape, aspirate and dissect, and ultra- sonic scalpel was usecl to cut in all the laparoseopie surgery. Results ： In all cases, 62 eases of LC were successful （ 96.9% ） , 1 case with bleeding and 1 case with preoperative suspected Mirizzi syndrome were converted to laparotomy. The average operation time and intraoperative hemorrhage was （127 ± 31 ） min and （115± 34） ml respectively. The average time of ambulation after operation was （ 17.2 ± 3.8 ） h and the recovery time of gastrointestinal function after operation was （23.5± 8.2） h. Bile leakage happened in 2 cases （3.2%）. Drainage tube was disposed in 46 patients （74.2%）. The average draining time was （4.7 _＋ 2.3 ） d. The mean hospital stay after operation was （6.6 -＋2.3） d and the average postoperative follow-up time was （8.2 -＋2.5） months. No jaundice, subphrenie in- fection,＂ remnant small gallbladder＂ or extrahepatie bile duct stricture happened. Conclusions：The curettage, aspiration and dissection technique for acute cholecystitis in LC is safe and practicable. The key is adequate preoperative discussion and evaluation. Suction appa- ratus and ultrasonic scalpel are useful tools to dissect Calot triangle, thus hemorrhage and bile duct injury could be avoided and the occurrence of intraoperative complication and conversion to laparotomy is also declined.