腹腔镜胆囊切除术治疗急性坏疽性胆囊炎36例

目的探讨应用腹腔镜胆囊切除术治疗急性坏疽性胆囊炎的手术技巧。方法回顾性分析2008年4月至2012年1月收治的36例急性坏疽性胆囊炎患者的临床资料,均行腹腔镜胆囊切除术（LC）。结果 36例均成功完成手术,其中2例中转开腹,术后无出血、胆瘘、胆总管损伤等并发症发生,术后住院3～7d,1例术后第7天（已出院）发生下肢深静脉血栓,经溶栓治疗痊愈。结论急性坏疽性胆囊炎为LC的相对适应证,术中联合应用吸引器、纱布压迫等方法,可以减少出血,保持术野清晰,容易辨认组织结构,减少和避免术中误伤和术后并发症的发生。

The report of laparoscopic cholecystectomy for 36 patients with acute gangrenous cholecystitis

Objective To analyze and discuss surgical techniques used in laparoscopic treatment of acute gangrenous cholecystitis.Methods Treatment course of 36 patients with acute gangrenous cholecystitis treated with laparoscope from April 2008 to January 2012 were retrospectively analyzed.Results In this cohort of patients,laparoscopic surgery was converted to open surgery in 2 patients,none of the patients had local complications such as hemorrhage,biliary fistula and injury of the common bile duct,1 patient developed lower limb deep-vein thrombosis 7 days after the surgery,which was cured with thrombolytic treatment,postoperative hospital stay ranged from 3 to 7 days.Conclusions Acute gangrenous cholecystitis is a relative indication for laparoscopic surgery.Combined use of a suction device and gauze compression during the procedure may help to reduce bleeding,keep the operating field clear,identify tissue structures,and reduce and avoid intra-operative inadvertent injuries and post-operative complications.