摘要:Objective To explore the security and feasibility of modified mini-laparoscopic cholecystectomy dealed with cystic duct and cystic artery by silk ties instead clips. Methods 458 patients of LC surgery during 2008 January ~ May 2011, were divided into two groups: 112 cases (22.45%) using modified mini-laparoscopy, treatment of cystic duct with a silk tie and successful complete the cystic artery surgery;The others 346 patients using conventional rabbit clip. Compare the rate of convert to open operation, operative time, blood loss, drainage tube placed time and complications. Results In conventional group, 3 cases (0.87%) convert to open operation; and in modified mini-laparoscopic group, 1 case (0.89%) convert to open operation. There were no significant difference in the two groups from the operative time, blood loss, drainage tube placed time. Patients hadn't complications such as bleeding, bile leakage and intra-abdominal infection. Follow-up of 402 cases (modified group of 80 patients, conventional group 322 cases) ,there were no patients have abdominal pain, jaundice and fever and other symptoms. Modified group and the conventional are no significant clinical differences (P> 0.05), and achieve a good cosmetic effect P <0.05. Conclusion Modified mini-laparoscopic by using silk tie and ultrasonic surgical knife in treatment of cystic duct and cystic artery is a reliable, safe , and can effectively avoid the complications of the clip, the patient's surgery is more beautiful.%目的:探讨改良迷你腹腔镜胆囊切除术(LC)中用丝线打结替代夹子处理胆囊管和胆囊动脉的安全性和可行性.方法:2008年1月~2011年5月458例LC手术中,112例(22.45%)采用改良迷你腹腔镜,用丝线打结处理胆囊管及胆囊动脉顺利完成手术中,346例常规方法(兔夹子处理),对比两组转开腹手术比率、手术时间、术中出血量及放置引流管时间、术后并发症的差异.结果:常规LC组术转开腹手术3例(0.87%),免夹子及超声刀迷你腹腔镜组术中转开腹手术1例(0.89%),两组患者从手术时间、术中出血量,放置引流管无明显的差异.术后均未出现出血、胆漏、腹腔感染等并发症.随访402例(改良组80例,常规组322例)患者均未出现腹痛、黄疸及发热等症状.改良组与常规组临床疗效无明显的差异性(P>0.05).结论:采用改良迷你腹腔镜,用丝线打结处理胆囊管及胆囊动脉的方法是可靠,安全,且能有效地避免夹子的并发症,患者的手术更美观.