【摘要】 目的探讨用可吸收缝线结扎胆囊管和胆囊血管行免钛夹腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗胆囊颈部结石嵌顿无或伴急性胆囊炎的安全性及可行性。方法 2008年12月～2010年7月53例胆囊颈部结石嵌顿无或伴急性胆囊炎全麻下行三孔法LC,采用分离钳、电凝钩、吸引器显露胆囊,对胆囊肿大、张力高的病人采用胆囊底、体部穿刺、打孔减压,保持胆囊颈部完整,根据胆囊三角情况采用顺行或逆行方式切除胆囊。解剖出胆囊管和胆囊动脉,用分离钳将长约10 cm的可吸收线(强生公司Vicryl 31 mm 1/2c)送入腹腔,腹腔内打结结扎胆囊管及胆囊血管的近端,远端不结扎用电凝钩电凝直接离断。根据术中情况术后放置或不放腹腔引流管。结果 53例手术全部成功,无中转开腹,未使用超声刀、钛夹及其他种类夹子。49例顺行胆囊切除,4例逆行胆囊切除,所有病例均未行胆囊颈部切开取石。手术时间30～70min,平均42 min;术中出血量15～200 ml,平均24 ml。18例放置腹腔引流1,～6 d拔出腹腔引流管,平均1.8 d。术后住院3～7 d,平均3.5 d。53例随访1～18个月,平均7.6月,无胆管损伤、出血、胆漏和腹腔感染等并发症。结论 LC中用可吸收缝线代替钛夹或其他夹子及超声刀处理胆囊管及胆囊血管治疗胆囊颈部结石嵌顿安全、可行。更多还原

【Abstract】 Objective To evaluate the safety and feasibility of laparoscopic cholecystectomy(LC) by using absorbable suture instead of titanium clips and harmonic scalpel for patients with gallstone incarcerated in the neck of the gallbladder with or without acute cholecystitis.Methods From December 2008 to July 2010,we performed totally 53 cases of LC for incarcerated gallstone in the gallbladder neck with acute cholecystitis without using titanium clips.First,we dissected the gallbladder by clamps,coagulation hook and suction.For gallbladder with empyema and high pressure we carried out puncturing or making small hole on the bottom or body of the gallbladder to reduce the pressure,and kept the neck closed.According to the condition of Calot’s triangle we adopted an anterograde or retrograde LC.After dissecting the cystic duct and artery,we ligated their proximal end with a 10-cm absorbable suture(Vicryl 31mm 1/2c) and cut the distal ends by coagulation hook,knots were made intraperitonealy by clamps.Results All the operations were successfully completed without converting to open surgery nor using clips and harmonic scalpel.Among the patients,49 received anterograde LC and 4 retrograde LC.During the operation,in no patient,the stones were removed by opening the gallbladder neck in order to perform LC easily.The mean operation time was 42 minutes(ranged from 30 to 70 minutes).The intraoperative blood loss raged from 15 to 200 ml(mean,24 ml).18 patients received intraperitoneal drainage,for a mean of 1.8 days(ranged from 1 to 6 days).Postoperative hospital stay was 3-7 days(mean,3.5 days).The follow-up time was 1 to 18 months(mean,7.6 months),during which no bleeding,biliary leakage,postoperative intra-abdominal infection occurred.Conclusion It is safe and feasible to perform LC by using absorbable suture in stead of clips and harmonic scalpel for gallstone incarcerated in the neck of the gallbladder with acute cholecystitis.更多还原