摘要:目的:探討腹腔鏡膽囊大部分切除在復(fù)雜膽囊結(jié)石手術(shù)中應(yīng)用的可行性及安全性。方法:回顧性分析2003年1月至2008年10月間41例行腹腔鏡膽囊部分切除術(shù)的復(fù)雜膽囊結(jié)石病人。行腹腔鏡膽囊切除術(shù)指征為:膽囊管不能明確辨認(rèn)時,諸如:膽囊積膿、Mirris綜合征、Calot三角致密粘連呈“冰凍樣”、萎縮性膽囊等。手術(shù)方法為:切除膽囊前壁,取凈結(jié)石,腹腔置管引流。結(jié)果:41例復(fù)雜膽囊結(jié)石病人中1例中轉(zhuǎn)開腹手術(shù)外,其余全部在腹腔鏡下完成,手術(shù)時間為45～145分鐘,平均(57.42±19.41)分鐘,1例術(shù)后出現(xiàn)膽漏,其余術(shù)后住院時間為2～7天。 結(jié)論:在膽囊三角不能安全辨認(rèn)前提下,對于復(fù)雜膽囊結(jié)石行腹腔鏡膽囊部分切除術(shù)是一種安全的手術(shù)方式,不但能簡化手術(shù)、降低手術(shù)風(fēng)險,而且能避免行開腹手術(shù)治療。
Abstract: Objective: To study the possibility and safty of laparoscopic subtotal cholecystectomy in complicated cholecystectomy. Methods: Laparoscopic subtotal cholecystectomy was performed when the cystic duct cannot be identified safely, such as empyema cholecystitis, Mirris syndrome, frozen Calot’triangle, shrunken gallbladder. The operation consists of resecting the anterior wall of the gallbladder, removing all stones, and placing a large drain. 41 patients who underwent a laparoscopic subtotal cholecystectomy between 1 January 2003 and 31 October 2008 were retrospectively analyzed. Results: Fortyone cases of complex laparoscopic cholecystectomy were performed. 1 cases in which were changed to open cholecystectomy. Operating time was 45145 min, average (57.42±19.41) min. 1 cases were reoperated because of the bile leak. Hospital stays were 27 days. Conclusion: Laparoscopic subtotal cholecystectomy is a viable procedure during cholecystectomy in which Calot’s triangle cannot be safely dissected. It may simplify the operation and decrease the risk in complicated cholecystectomy and averts the need for a laparotomy.

引用本文： 田銀生. 腹腔鏡膽囊部分切除術(shù)在復(fù)雜膽囊結(jié)石手術(shù)中的應(yīng)用. 華西醫(yī)學(xué), 2009, 24(11): 2865-2866. doi: 復(fù)制

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