开腹胆囊切除术复杂情况的评估与对策

摘要

目的 总结开腹胆囊切除术(OC)中可能出现的复杂情况和处理对策,以降低风险,减少手术并发症.方法 分析我院行OC的56例患者的临床资料,并回顾手术操作过程.结果 OC术中所见复杂情况包括坏疽性胆囊炎、急性胆囊炎伴胆囊穿孔、萎缩性胆囊炎(合并Mirriz综合征、胆囊内瘘)、残留胆囊等.OC中行顺行法6例,逆行法5例,顺逆结合法26例,其余19例根据术中情况灵活机动地行个体化手术.56例患者中有55例经OC治愈,且无胆瘘、胆道副损伤等并发症发生,另1例胆囊癌行姑息性手术,术后恢复顺利.结论 术前综合分析患者的临床资料,评估手术难度,制定合理对策,术中采用灵活机动的个体化方法显露胆囊及三管关系,是应对OC术中复杂情况的关键措施.%Objective To summarize the complex situation and the treatment strategies of patients during open cholecystotomy(OC) to decrease the risk and complication of OC.Methods The clinical data of 56 cases taken OC were analyzed and the operation process in our hospital was reviewed.Results The complex situation included acute cholecystitis which could not recover from the medical treatment,gangrene and perforation,atrophic cholecystitis(with Mirriz syndrome,Cholecysto-enteric fistula)and remained gallbladder.Six patients were given conventional choleccystectomy,5 patients were given retrogradation choleccystectomy and 26 patients were given combine methods above.19 patients were taken flexible and personalized operation methods to resect gallbladder according to the operation situation.Among these 56 cases,55 cases were cured.There were no bile leaks and bile duct injures.One case of gallbladder cancer had palliative surgery and recovered well.Conclusion Comprehensive analysis of clinical data,rational strategies before operation,flexible and personalized method to reveal gallbladder and gallbladder duct,bile duct and the common duct during OC are key to reduce the complications of OC with complex situation.