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: Fortyone cases of complex laparoscopic cholecystectomy were performed. 1 cases in which were changed to open cholecystectomy. Operating time was 45145 min, average (57.42±19.41) min. 1 cases were reoperated because of the bile leak. Hospital stays were 27 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.
目的探討腹腔鏡膽囊次全切除術(shù)(laparoscopic subtotal cholecystectomy，LSC)治療膽囊結(jié)石合并膽囊嚴(yán)重炎癥、粘連或萎縮的可行性及手術(shù)技巧。方法回顧性分析我院從2006年1月至2010年4月期間83例膽囊結(jié)石合并膽囊嚴(yán)重炎癥、粘連或萎縮患者實施LSC手術(shù)的臨床資料。結(jié)果81例施行LSC，2例中轉(zhuǎn)開腹。39例膽囊底、體部部分膽囊壁殘留，26例膽囊頸部部分殘留，18例膽囊體部及膽囊頸部均部分殘留。手術(shù)時間60~130 min，平均75 min。術(shù)中出血20~200 ml，平均75 ml。術(shù)后恢復(fù)飲食時間6~48 h，平均19 h。術(shù)后帶引流管時間48~150 h，平均77 h; 引流液總量30~210 ml，平均85 ml。無嚴(yán)重膽汁漏、膽汁性腹膜炎及術(shù)后大出血發(fā)生。全組病例痊愈出院。術(shù)后住院時間4~10 d，平均6.1 d。51例隨訪3~48個月，平均22個月，2例分別于術(shù)后6個月及13個月B超復(fù)查發(fā)現(xiàn)類似“小膽囊”改變，均無明顯臨床癥狀，未作特殊治療處理。隨訪患者中未見典型膽囊切除術(shù)后綜合征表現(xiàn)。結(jié)論對于膽囊結(jié)石合并膽囊嚴(yán)重炎癥、粘連或萎縮患者，無法行常規(guī)LC時，行LSC是安全、有效、可行的，既可有效防止膽管損傷、異常出血等嚴(yán)重并發(fā)癥發(fā)生，又可有效減少中轉(zhuǎn)開腹率。