摘要
目的探讨腹腔镜胆囊切除术中胆囊床剥离的危险因素与防范措施。方法对接受腹腔镜胆囊切除术中用传统胆囊床剥离方法完成的490例患者资料进行回顾性分析，同期随机选取500例采用改良腹腔镜胆囊床剥离方法的患者进行前瞻性研究。结果传统方法完成的490例患者中，发生肝中静脉床面属支损伤大出血3例，胆囊动脉后支床面分支出血2例，术后诊断胆囊床胆漏5例，变异右肝门静脉损伤2例，变异右肝管损伤1例。改良胆囊床剥离法完成的500例患者中，无一例发生严重手术并发症，同时解剖观察显示胆囊床胆囊动脉后支床面分支占39．6％（198／500），肝中静脉床面属支占11．2％（56／500），其分布以胆囊床面右侧居多，床面扩张的迷走胆管占2．2％（11／500），变异裸露右肝管占0．6％（3／500），右肝门静脉分支占0．4％（2／500）。结论在腹腔镜胆囊切除术中行胆囊床剥离时存在潜在的手术风险。术中遇意外性损伤，应及时中转开腹。改良腹腔镜胆囊床剥离法有助于防范胆囊床剥离的手术风险。
Objective To discuss risk factor and operation guard in dissection of cholecyst from its bed during laparoscopic cholecystectomy. Methods The clinical data of 490 cases of laparoscopic cholecystectomy dissect cholecyst from its bed by traditional method during were retrospectively analyzed and simultaneously perspective study on 500 cases of improved laparoscopic cholecystectomy dissecting cholecyst from its bed. Results There are 3 cases in hemorrhea due to injuring bed branchs of arteria cystica posterior branch,2 cases in bed branehs of arteria cystica posterior branch haemorrhage, 5 cases in postoperative bile leak,2 cases in variant right hepatic portal vein injury, 1 case in variant right hepatic duct in the 490 cases of laparoscopic cholecystectomy by traditional method. Using our new technique exposed,and then ligated 39.6 % （198/500） bed branchs of arteria cystica posterior branch, 11.2 % （56/500） bed branchs of venae hepaticae intermediate almost in right side of eholecyst bed,2.2 % （11/500） dilated aberrant bile-duct duct. We separated and then protected 0.6 % （3/500） unusual right hepatic duct being exposed, 0.4%（2/500） right liver branch of portal vein. Conclusion There are some larvate risk in isolation of cholecyst from its bed during laparoscopic cholecystectomy. Unexpected injury happen during LC, and it ought to be open cholecystectomy The improved method provides a safe,efficiency operative procedure.
出处
《中国基层医药》
CAS
2008年第8期1315-1316,共2页
Chinese Journal of Primary Medicine and Pharmacy
关键词
腹腔镜
胆囊
危险因素
Laparoscopic cholecystectomy
Cholecyst
Risk factor
