【摘要】 目的探讨胆囊急性炎症期行腹腔镜胆囊切除术(LC)中胆囊管和胆囊动脉的处理方法。方法对1579例胆囊急性炎症期行LC手术的患者临床病历进行回顾性分析。结果胆囊管和动脉丝线结扎组1359例术后仅发生胆囊床胆漏1例,经再次手术引流治愈。胆囊颈管缝合组125例术后出现严重胆漏2例,经保守治疗治愈;小胆囊形成伴胆囊管残余结石1例再次开腹手术切除治愈。胆囊管未作特殊处理组43例术后出现胆漏2例,均经保守治疗治愈;活动性出血1例经开腹手术止血治愈;肝下积液继发感染1例,经穿刺置管引流治愈。完成腹腔镜手术组共1527例,其中术后近期发生严重并发症7例(0·46%),全组均治愈出院。结论在胆囊急性炎症期LC术中,采用结扎或缝扎胆囊管和胆囊动脉等处理技巧可降低术中风险,减少中转开腹手术率和术后并发症发生率。更多还原

【Abstract】 ObjectiveTo investigate the various procedures of laparoscopic cholecystectomy for acute cholecystitis. MethodsThe data of 1579 patients with acute cholecystitis admitted into our hospital from May 1995 to Aug. 2007 were reviewed retrospectively. ResultsAmong the 1359 patients who underwent gallbladder duct and corresponding artery ligation, only 1 patient was found bile leakage from the gallbladder bed and was healed by reoperative drainage. Out of 125 patients who received gallbladder neck suturation, 2 patients had bile leakage and were healed after conservative therapy; 1 case inflicted with small gallbladder formation concurrent retained calculus at the gallbladder duct was healed by reoperative resection. Among the 43 patients whose gallbladder duct was not specially managed, bile leakage appeared in 2 cases and was healed after conservative measures; active bleeding in 1 case was healed by surgical hemostasis; subhepatic hydrops and secondary infection in 1 case and was healed by puncture and indwelling drainage. 1527 patients were conducted laparoscopic operation, in whom 7 patients sustained severe postoperative complications, but all of them were recovered well. ConclusionAdoption of some skills such as ligation or transfixion of the duct and artery of the gallbladder can reduce operative risks and postoperative complications and accordingly gain a favorable effect in laparoscopic cholecystectomy for acute cholecystitis patients.更多还原