刮吸解剖法在急性胆囊炎腹腔镜胆囊切除术中的应用

目的探讨刮吸解剖法在急性胆囊炎腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）中的应用价值。方法2002年8月-2008年1月,借助腹腔镜多功能手术解剖器（laparoscopic Peng,s multifunctional operative dissector,LPMOD）应用刮吸解剖法对820例急性胆囊炎施行LC。对有胆道相对探查指征的158例（143例有胆总管扩张）行术中胆道造影,发现胆总管结石17例,其中14例完成腹腔镜下胆总管探查术（laparoscopic common bile duct exploration,LCBDE）。结果812例LC成功,8例中转开腹。LC平均手术时间55 min（25-120 min）,LC＋LCBDE平均手术时间95 min（80-130min）,术中平均出血量25 ml（0.5-80 ml）,术后平均住院5 d（3-9 d）。无胆管损伤、胆漏、术后出血等并发症。804例随访2-18个月,平均11个月,2例胆总管残余结石（1例行开腹胆总管切开取石,1例行EST取石）,其余患者未发现与手术相关并发症。结论在急性胆囊炎腹腔镜胆囊切除术中应用刮吸解剖法能有效防止术中胆道损伤,安全可靠,值得临床推广。

Application of Curettage and Aspiration Dissection Technique in Laparoscopic Cholecystectomy for Acute Cholecystitis

Objective To discuss the efficacy of curettage and aspiration dissection technique in laparoscopic cholecystectomy for acute cholecystitis. Methods From August 2002 to January 2008, we used the laparoscopic Peng＇ s multifunctional operative dissector （LPMOD） to perform laparoscopie cholecystectomy on 820 cases of acute choleeystitis. Among the cases, 158 patients who had indications （143 of them had enlarged common bile duct） underwent intraoperative cholangiography, and common bile duct stones were detected in 17 of them. Of the 17 cases, laparoscopic common bile duct exploration （LCBDE） were carried out in 14. It was found that 17 cases of the patients had stones in the common bile duct. 14 patients with the common bile duct stones underwent laparoscopic common bile duct exploration. Results The LPMOD was completed successfully in 812 patients, the other 8 were converted to open surgeries. The mean LC time was 55 rain （25 -120 min） , and the mean LC plus LCBDE time was 95 min （80 - 130 min）. The mean blood loss of the patients was 25 ml （0.5 -80 ml） , and the patients were discharged from the hospital in 3 to 9 days （mean, 5 days）. No bile duct injury, biliary leak, or postoperative hemorrhage occurred in this series. Follow-up was available in 804 patients for a mean of 11 months （2 - 18 months）. During the period, two patients showed residual stones in the common bile duct, and were cured by open surgery or EST. No other complications were found. Conclusions Curettage and aspiration dissection technique is safe and reliable to avoid bile duct injury during laparoscopic cholecystectomy.