腹腔镜胆囊切除术治疗急性坏疽性胆囊炎的临床分析_West China Medical Journal

Authors：

 何贤禄 , 刘伟

核工业四一六医院普外科 (成都 610051);

Corresponding author：

Keywords：

腹腔镜胆囊切除术; 急性胆囊炎; 胆囊切除术; 胆囊结石

DOI：

10.7507/1002-0179.201600198

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目的探讨腹腔镜胆囊切除术治疗急性坏疽性胆囊炎的可行性及手术技巧。方法回顾分析2004年9月－2014年8月经腹腔镜胆囊切除术治疗急性坏疽性胆囊炎的89例患者的临床资料。结果 89例患者中，83例顺利行腹腔镜胆囊切除术，6例中转开腹，中转开腹率6.74%。83例顺利行腹腔镜胆囊切除术的患者手术时间60～150 min，平均120 min；顺行切除45例，逆行切除20例，顺行逆行结合切除18例；术中胆囊穿刺减压78例，胆囊坏疽穿孔处减压5例；72例Calot三角瘢痕样致密粘连，吸引器钝性分离解剖Calot三角65例，横断胆囊壶腹部或壶腹部前后贯通逆行分离胆囊颈管13例，剖开胆囊协助分离胆囊颈管5例，残留胆囊床部分胆囊壁的胆囊切除15例；1例术后发生胆漏经引流后痊愈，1例脐部戳孔感染。术后平均住院时间4 d。结论术中胆囊减压，保持术野清晰，灵活应用吸引器钝性分离，顺行逆行分离结合，胆囊壶腹部前后贯通或离断等多种手术技巧，有利于提高急性坏疽性胆囊炎行腹腔镜胆囊切除术的安全性。

Citation： 何贤禄, 刘伟. 腹腔镜胆囊切除术治疗急性坏疽性胆囊炎的临床分析. West China Medical Journal, 2016, 31(4): 731-733. doi: 10.7507/1002-0179.201600198 Copy

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1. Borzellino G, Sauerland S, Minicozzi AM, et al. Laparoscopic cholecystectomy for severe acute cholecystitis. A meta-analysis of results[J]. Surg Endosc, 2008, 22(1): 8-15.
2. Tsushimi T, Matsui N, Takemoto Y, et al. Early laparoscopic cholecystectomy for acute gangrenous cholecystitis[J]. Surg Laparosc Endosc Percutan Tech, 2007, 17(1): 14-18.
3. Asoglu O, Ozmen V, Karanlik H, et al. Does the complication rate increase in laparoscopic cholecystectomy for acute cholecystitis?[J]. J Laparoendosc Adv Surg Tech A, 2004, 14(2): 81-86.
4. Catena F, Ansaloni L, Bianchi E, et al. The ACTIVE (acute cholecystitis trial invasive versus endoscopic) study: multicenter randomized, double-blind, controlled trial of laparoscopic versus open surgery for acute cholecystitis[J]. Hepatogastroenterology, 2013, 60(127): 1552-1556.
5. Contini S, Corradi D, Busi N, et al. Can gangrenous cholecystitis be prevented: a plea against a “wait and see” attitude[J]. J Clin Gastroenterol, 2004, 38(8): 710-716.
6. Gomes RM, Mehta NT, Varik V, et al. No 72-hour pathological boundary for safe early laparoscopic cholecystectomy in acute cholecystitis: a clinicopathological study[J]. Ann Gastroenterol, 2013, 26(4): 340-345.
7. Meng FY, Tsao MZ, Huang ML, et al. Laparoscopic cholecystectomy techniques with special care treatment in acute cholecystitis patients regardless of operation timing[J]. Hepatogastroenterology, 2012, 59(116): 1006-1009.
8. Degrate L, Ciravegna AL, Luperto M, et al. Acute cholecystitis: the golden 72-h period is not a strict limit to perform early cholecystectomy. Results from 316 consecutive patients[J]. Langenbeck’s Arch Surg, 2013, 398(8): 1129-1136.
9. Hubert C, Annet L, Van Beers BE, et al. The “inside approach of the gallbladder” is an alternative to the classic Calot’s triangle dissection for a safe operation in severe cholecystitis[J]. Surg Endosc, 2010, 24(10): 2626-2632.
10. Stefanidis D, Bingener J, Richards M, et al. Gangrenous cholecystitis in the decade before and after the introduction of laparoscopic cholecystectomy[J]. JSLS, 2005, 9(2): 169-173.

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West China Medical Journal

腹腔镜胆囊切除术治疗急性坏疽性胆囊炎的临床分析

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