复杂困难结石性胆囊炎腹腔镜胆囊切除术的临床体会

摘要

Objective:To study the clinical value and operation method of laparoscopic surgery in the treatment of complex calculous cholecystitis.Methods:The clinical data of 105 patients received laparoscopic cholecystectomy for complex calculous cholecystitis from Mar.2008 to Dec.2015 were analyzed.Results:Of all the 105 cases,103 cases underwent laparoscopic surgery successfully (98.1%),2 cases were converted to laparotomy (1.9%).Intraoperative bleeding was (65.0±12.5) ml (range 10-400 ml).No blood transfusion was required in any cases.Abdominal negative pressure drainage tube was routinely placed.The drainage tube was placed for (3.5±0.5) d (range 3-10 d) and the drainage volume was (35.7±14.5) ml (range 20-180 ml).All patients were cured and discharged from hospital without any significant bleeding,bile leakage,biliary stricture,subphrenic infection,adhesive intestinal obstruction or other serious complications after surgery.Conclusions:Laparoscopic cholecystectomy is safe and feasible for complex calculous cholecystitis with thorough preoperative examinations and full knowledge of the condition of the biliary system as well as skilled,experienced and well-cooperated performers.%目的:探讨腹腔镜手术治疗复杂困难结石性胆囊炎的手术方法及临床应用价值.方法:总结分析2008年3月至2015年12月为105例复杂困难结石性胆囊炎患者行腹腔镜胆囊切除术的临床资料.结果:105 例患者中,103 例(98. 1%)顺利完成腹腔镜手术,2例(1.9%)中转开腹.术中出血量10~400ml,平均(65.0±12.5)ml,均未输血.术中常规留置腹腔负压引流管,腹腔引流液体量20~180ml,平均(35.7±14.5)ml,引流管放置时间3~10d,平均(3.5±0.5)d.术后均未出现明显出血、胆漏、胆管狭窄、膈下感染、粘连性肠梗阻等严重并发症,患者均治愈出院.结论:术前应尽量完善各项检查,明确胆囊、结石、胆管及胆总管情况,做到术前心中有数;术者、助手应熟练掌握腹腔镜技术,规范操作,清楚了解胆道系统解剖及病理改变,操作时配合默契,为复杂困难性结石性胆囊炎患者行腹腔镜胆囊切除术是安全、可行的.