腹腔镜胆囊切除术治疗急性穿孔性胆囊炎27例报告

摘要

目的 探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗急性胆囊炎并穿孔的可行性.方法 2006年1月～2009年12月,对27例急性胆囊炎并穿孔行三孔或四孔法LC治疗.结果 腹腔镜下胆囊大部分切除18例,完整切除7例,中转开放手术2例(7.4%).死亡1例(3.7%).术后并发症发生率29.6%(8/27),包括胆漏2例,胆总管狭窄1例,膈下积液2例,肺部感染2例,多器官功能衰竭死亡1例.无切口感染.26例术后随访2～24个月,平均14个月.1例术后3个月粘连性肠梗阻,二次手术行肠粘连松解术.结论 腹腔镜手术治疗急性胆囊炎并穿孔是有效、安全的.%Objective To explore the clinical therapeutic effect and reliability of laparoscopic cholecystectomy (LC) for acute cholecystitis with perforation.Methods Totally 27 cases of acute cholecystitis with perforation were treated by LC from January 2006 to December 2009 in our hospital.We analyzed their clinical data retrospectively.Results Among the 27 cases, 18 cases were treated by subtotal laparoscopic cholecystectomy, 7 cases received total laparoscopic cholecystectomy, and 2 cases were converted to open surgery (7.4％).One case died (3.7％) during the procedure.The postoperative complication rate of LC was 29.6％ (8/27) and the complications included biliary fistula (2 cases) , extrahepatic bile duct stricture (1 case), subphrenic hydrops (2 cases), lung infection with pleural cavity hydrops (2 cases), and multiple organ dysfunction syndrome (died, 1 case).Follow-up after the operation was carried out in 26 of the cases for 2 to 24 months (mean, 14 months).At 3 months during the follow-up, one patient developed adhesive intestinal obstruction and thus received adhesion lysis.Conclusion LC is effective and safe for patients with acute cholecystitis with perforation.