摘要
目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)急诊手术时的一些问题及技巧。方法:我院为402例慢性胆囊炎急性发作患者行急诊LC,术中先行胆囊减压,将胆囊颈部嵌顿的结石反向推至胆囊内,恢复胆囊三角的解剖关系,明确手术入点,然后紧贴胆囊颈部分离解剖胆囊管及胆囊动脉,放置引流管。结果:所有LC均顺利完成,除2例术后因炎症出现胆漏外,无其他并发症发生。结论:腹腔镜手术时,术者不但要有一定的开腹手术经验,而且要具有良好的屏幕-眼-手协调操作能力;作好术前检查,尤其重视相关的影像学检查,掌握手术适应证;正确掌握术中处理技巧,了解胆囊减压的重要性和方式,认真处理好急诊条件下的一些特殊情况;重视并正确掌握LC中转开腹的手术时机;重视引流管的放置和观察;腹腔镜治疗慢性胆囊炎、胆囊结石急性发作患者相对还是创伤小、安全、康复快的治疗方式。
Objective ：To discuss some skills and methods of emergency laparoscopic cholecystectomy （LC）. Methods：All the 402 cases of chronic cholecystitis with acute occurrence underwent emergency LC. First, perform gallbladder decompression, then push the stone back into the gallbladder and restore the anatomic relationship of Calot triangle. Make clear the operation point and separate the cystic duct and artery. Lay the drainage tube finally. Results：The operation was smoothly performed. There were no complications except for two cases of biliary fistula. Conclusions： Surgeons should have not only the experience of open abdominal operation, but also coordination ability of screens, eyes and hands. Perfect examination should be carried out before operation, especially those closely related imaging examination. Meanwhile, pay attention to the indications. Master the operation skills correctly, such as decompression of gall- bladder. Grasp the time of conversion to open cholecystectomy, and emphasize placement and observation of the drainage tube. Emergency LC is a good treatment for chronic cholecystitis and cholecystolithiasis acute episode with little trauma,quick recovery and safety.
出处
《腹腔镜外科杂志》
2008年第3期243-245,共3页
Journal of Laparoscopic Surgery
关键词
急性胆囊炎
胆囊切除术
腹腔镜
手术技巧
Acute cholecystitis
Cholecystectomy, laparoscopic
Operation skills
