【摘要】 胆囊切除术虽不困难,但由于胆囊局部关系比较复杂,且有多种变异,手术意外仍有发生。作者以100例胆囊动脉形态学的研究为基础,结合手术的需要,从手术区域的显露、胆囊管的分离与处理、胆囊动脉的结扎、胆囊的游离与切除几方面提出自己的经验。更多还原

【Abstract】 Choose a right upper transrectus or a Graham incision. The first assistant’s left hand, or a retractor, draws the duodenal bulb downwards. A secondretractor draw the liver upwards, thus opening up the space between liverand duodenum. Grasp the neck of the gallbladder with forceps and draw itto the right side. This threeway traction provides good exposure. Dissectionis begun with scissors over the cystic duct and continued downward exposingthe cystic, common hepatic, and commen ducts. Nothing should be severedor incised until accurately identified. The cystic duct and cystic arteryare dissected free while held taut by traction on the gallbladder. The cysticduct is clamped at its junction with the gallbladder and severed betweenthe clamp and ligature. The cystic artery is next ligated and severed nearthe gallbladder. The gallbladder can be dissected from its bed with scissors orcurved knife. Any bleeding points or severed accessory bile duets are ligated.Anomalies of the biliary ducts and regional blood vessels are very frequent.To avoid accidents, adequate exposure and recognition of each anatomicalstructure are essential.更多还原