急性坏疽性胆囊炎的'冷分离'腹腔镜胆囊切除术

摘要

目的 探讨急性坏疽性胆囊炎时"冷分离"腹腔镜胆囊切除术的可行性以及手术技巧.方法 回顾性分析河南科技大学第一附属医院普外科41例急性坏疽性胆囊炎行腹腔镜胆囊切除术的临床资料.术中采用分离钳剥离、配合吸引器刮吸的"冷分离"技术切除胆囊.结果 39例完成腹腔镜胆囊切除术,2例中转开腹手术,手术中转率为4.9%.手术时间为(70.37±13.35) min,术中无肝胆管损伤,术后无胆囊床渗血或胆漏发生.术后并发切口感染2例,切口血清肿1例,下肢浅静脉血栓形成1例,右下肺感染1例,均治愈出院.本组前12例平均手术时间为(86.67±11.69) min;后29例平均手术时间为(63.55±6.23) min,两者比较,差异有统计学意义(P<0.01).结论 急性坏疽性胆囊炎行"冷分离"腹腔镜胆囊切除术安全可行,分离钳和吸引器相结合的"冷分离"技术是手术成功的有效方法.%Objective To explore the feasibility and surgical technique of "cold dissection" in laparoscopic cholecystectomy for patients with acute gangrenous cholecystitis (AGC).Methods The clinical data of 41 patients with AGC operated using laparoscopic cholecystectomy in the First Affiliated Hospital,Henan University of Science and Technology during 2011 to 2016 were analyzed retrospectively.All the resections of gallbladder were performed through "cold dissection",which was stripped by dissecting forceps and combined with the suction of aspirator intraoperatively.Results Thirty-nine cases were subjected to laparoscopic cholecystectomy,and 2 cases converted to open cholecystectomy with the conversion rate of 4.9%.The mean operative time was (70.37±13.35) min.All the patients had no introperative injuries of hepatic duct or common bile duct,and had no bleeding or biliary leakage postoperativly.The postoperative complications included 2 cases of infection of incision,1 case of seroma of incision,1 case of thrombosis of superficial veins of lower extremity,and 1 case of pulmonary infection.All patients were cured and discharged.The mean operative time of the preceding 12 cases was (86.67±11.69) min and that of the subsequent 29 cases was (63.55±6.23) min (P<0.01).Conclusions The application of "cold dissection" in laparoscopic cholecystectomy for AGC patients was safe and feasible.The combination of dissecting forceps and aspirator is an effective method for the success of such operation.