上腹部手术史患者应用腹腔镜胆囊切除术29例报告

目的　探讨对有上腹部手术史患者进行腹腔镜胆囊切除术 (LC)的治疗效果 ,提出手术的注意事项 ,以提高此类病例LC的成功率 ,减少并发症。方法　对 1994年 10月至 2 0 0 0年 6月间行“四孔法”LC的1740例患者中有上腹部手术史的 2 9例病例进行分析。结果　本组 2 8例完成LC手术 ,成功率为 96 6 %。无胆总管损伤及手术死亡病例。手术时间 2 9～ 135min ,平均 71 4min。住院天数 3～ 15d ,平均 6 79d。结论　对有上腹部手术史的胆石症患者 ,LC仍可作为首选的治疗方法。上腹腔内粘连程度与前次手术的类型有关 ,与两次手术的间隔时间无明显关系。术前原切口B超检查可预测切口与腹腔脏器粘连情况 ,减少和预防穿刺并发症。

Clinical application of laparoscopic cholecystectomy in cases with surgical history of upper abdomen

Objective In order to increase the success rate of operation and decrease the compication,the curative effect of laparoscopic cholecystectomy(LC) was studied for the patients who had epigastric operation.Methods To analyze the state of illness of twenty nine patients from October 1994 to June 2000.Results The success rate of operation was 96.6%(28/29).There was no choledochus injury and death case.The average time for operating and average hospitalization time was 71.4min(29～135min) and 6.79d(3～15d) respectively.Conclusion LC is one of the first selective therapy for the patients who had cholelithiasis and epigastric operation.The extent of adhesion was associated with the type of operation and was not associated with interval time between the first operation and the second operation.The intra abdominel adhesion can be predicated by B ultrasonography and the complication can be decreased and prevented.