浆膜下CO_2气垫法在腹腔镜胆囊切除术中的应用

目的探讨浆膜下CO2气垫法腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的方法、适应证与应用价值。方法 2009年1月～10月,对47例LC于施行胆囊切除前,分别在胆囊三角区和胆囊床进行穿刺,浆膜下层注入CO2,使浆膜下层形成气垫,组织更加疏松,层次感放大,血管及胆管显露更清晰,然后按常规方法切除胆囊。结果 41例成功完成浆膜下CO2气垫法LC,术中易于清晰解剖与处理Calot三角区的血管及胆管结构,胆囊床组织疏松,易于掌握分离层面,分离显得简单、快捷,术中出血10 ml,手术时间11～29 min,平均17 min。另6例因胆囊床及胆囊三角慢性炎症"冰冻"样改变、急性炎症水肿严重、胆囊萎缩等原因无法采用本方法,而改行常规LC。所有患者手术顺利,无中转开腹,无术中大出血、胆管损伤等并发症。47例随访2～10个月,平均7个月,无再发胆绞痛、发热、黄疸,复查B超无胆管扩张、胆管狭窄、胆道结石。结论在LC术中,浆膜下CO2气垫法对辨认胆管及血管、增加胆囊床浆膜下间隙有帮助,放大层次感,利于清晰解剖与处理Calot三角区的血管及胆管结构,对帮助掌握胆囊床分离的层面等具有明显的作用,有一定的临床应用推广价值。

Subserosal CO2 Air-cushion for Laparoscopic Cholecystectomy

Objective To explore the feasibility,superiority and therapeutic effect of CO2 air-cushion under the serosa of the gallbladder in laparoscopic cholecystectomy（LC）. Methods From January to October 2009,in 47 cases of LC that were performed in our hospital,CO2 injection into the subserosal space in the gallbladder was carried out to make an air-cushion,so that to loosen the gallbladder bed tissues,enlarge the space,and made a clearer operational field. Results The procedure was completed in 41 of the cases,in which the bile ducts and vessels in the Calot＇s triangle were exposed clearly resulting in easier and quicker tissue separation and blood loss less than 10 ml.The mean operation time of the cases ranged from 11 to 29 min with a mean of 17 min.In the other 6 cases,the procedure was failed because of frozen chronic inflammation,acute inflammatory edema,severe edema or atrophy of the gall bladder,and thus the patients were converted to routine LC.In our patients,no conversion to open surgery,massive hemorrhage,or biliary injury occurred.The patients received a follow-up for 2 to 10 months with a mean of 7 months,during which no biliary colic,fever,or jaundice occurred,and B-ultrasonography showed no biliary dilation,stenosis or calculi. Conclusions CO2 subserosal air-cushion is helpful for recognizing the bile duct and vessels in the Calot＇s triangle,and enlarging the subserosal space in the gall bladder during LC,and thus we recommend it as a promising technique for the operation.