腹腔镜胆囊切除术中的复杂情况及处理对策

目的总结腹腔镜胆囊切除术(LC)中的复杂情况、手术经验及处理技巧。方法回顾性分析2005年2月至2011年4月期间在我院及外院共同参与施行的86例胆囊炎、胆囊结石、术中胆囊切除困难患者的临床资料,针对不同情况采用薄层解剖法、吸引器推剥法、镜下缝合、术中胆管造影等技术。结果全组86例,手术时间(68±23)min(25～210 min),出血量(55±13)ml(15～200 ml)。84例成功施行LC,2例因胆囊三角疤痕组织致密难以分离而中转开腹,无胆汁漏、术后出血、胆管狭窄、残余结石等严重并发症发生,均治愈出院。结论对于复杂情况的LC可采用薄层解剖、吸引器推剥、镜下缝合、术中胆管造影等方法结合开腹手术理念可顺利完成手术。

Complex Situations and Management Strategies During Laparoscopic Cholecystectomy

Objective To review the complex situation,surgical experience,and surgical technique of laparoscopic cholecystectomy(LC).Methods The clinical data of 86 patients who underwent LC in our hospital and the consulting hospitals from February 2005 to April 2011 were retrospectively analyzed.According to the complicated conditions,the different surgical techniques were applied during LC such as lamellar dissection,aspirater stripping method,laparoscopic suture,and intraoperative cholangiography.ResultsThe operation time was(68±23)min(25-210 min),blood loss was(55±13)ml(15-200 ml).LC was successfully performed in 84 of 86 cases.Only two patients received transferring laparotomy because of scar tissue in Calot triangle that was hard to dissect.No severe complications occurred,such as biliary leakage,bleeding after operation,stricture of bile duct,retained calculus,and so on.All the patients were cured before discharge.ConclusionLamellar dissection,aspirater stripping method,and laparoscopic suture combined with the view of laparotomy can be used to deal with complicated LC successfully.