腹腔镜手术治疗急性结石性胆囊炎183例临床的的体会.docVIP

腹腔镜手术治疗急性结石性胆囊炎183例临床的的体会 　　doi：10.3969/j.issn.1007-614x.2014.3.17 　　摘 要 目的：探讨急性结石性胆囊炎患者行腹腔镜胆囊切除术的术中处理及并发症的防治。方法：行LC治疗急性结石性胆囊炎患者183例，对其临床资料进行回顾性分析。结果：170例成功行胆囊切除术，4例行胆囊大部切除加胆囊黏膜电灼术，9例中转开腹，无死亡、无出血及胆管损伤。结论：急性结石性胆囊炎行LC是安全可行的。主张完善术前必要相关检查及准备后，尽早（最好在72小时内）实施手术，提高腹腔镜技术，适时中转开腹是防治并发症发生的关键。 　　关键词 胆囊结石病 胆囊炎 急性 胆囊切除术 腹腔镜 　　Clinical Experience of laparoscopic surgery for acute calculus cholecystitis of 183 cases 　　Zhang Guoyun，He Jiang 　　Wenshan City Peoples Hospital of Yunnan province，663000 　　Abstract Objective：To explore the intraoperative treatment and prevention and treatment of complications of acute cholecystitis patients treated by laparoscopic operation.Methods：We selected 183 cases of acute calculous cholecystitis with LC for the treatment from 2005 February to 2013 February，and the clinical data were retrospectively analyzed.Results：170 cases were successfully treated by laparoscopic cholecystectomy，4 cases underwent subtotal cholecystectomy and gallbladder mucosa electrocautery，9 cases were converted to laparotomy，and there were no death，no bleeding and bile duct injury.Conclusion：Acute calculous cholecystitis treated with LC is safe and feasible.We should improve the preoperative examination and necessary as soon as possible（preferably within 72 hours） to implement operation.Improving the laparoscopic technique and timely laparotomy is the key to the prevention of complications. 　　Key words Gallstone disease；Cholecystitis；Acute；Cholecystectomy；Laparoscope 　　资料与方法 　　2005年2月-2013年2月行LC治疗急性结石性胆囊炎患者183例，男81例，女102例，年龄26～72岁，平均51岁，既往有胆囊炎、胆囊结石病史者112例，首次发作者71例伴胆囊结石嵌顿者53例。术前均有典型的急性胆囊炎表现，腹部压痛、反跳痛、以右上腹最明显；多伴有恶心、呕吐及不同程度的寒战、发热。发病48小时内51例，48～72小时93例，超过72小时39例；29例可触及肿大的胆囊，136例Murphy征阳性。术前结合B超（彩色B超）和核磁共振水成像显示胆囊肿大141例，胆囊壁厚0.5～1.2cm，部分病例胆囊壁呈双边征（65例），胆囊颈部结石嵌顿53例，胆总管直径0.6～0.9cm，胆囊窝积液21例。 　　手术方法：全身麻醉，患者取头高脚底位，左侧倾斜20°～30°位，可选用三孔法及四孔法视术者经验集合术中具体情况而定。维持气腹压力10～16mmHg，首先探查腹腔，观察胆囊周及Calot三角粘连程度，胆囊结石嵌顿部位，如果胆囊周围粘连形成包裹时可先分离粘连，显露胆囊轮廓及胆囊壶腹后结合彩色B超和核磁共振水成像资料初步判定可实行LC。分离粘连显露Calot三角，若胆囊张力高