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急诊腹腔镜治疗重症急性胆囊炎临床分析 被引量:2

Clinical analysis of emergency laparoscopic treatment for acute cholangitis of severe type
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摘要 目的:探讨腹腔镜胆总管切开取石T管引流术治疗重症急性胆囊炎(ACST)的临床疗效。方法:收集2004年4月~2007年10月收治的80例重症急性胆管炎患者,运用腹腔镜胆总管切开取石T管引流术进行急诊手术治疗。结果:重症急性胆囊炎80例,76例成功实施LC,其中,胆囊穿刺减压+胆总管切开取石T管引流11例,胆总管切开取石T管引流15例,胆囊造瘘+胆总管切开取石T管引流14例,胆囊切除+胆总管切开取石T管引流36例,手术时间15~120 min,术中出血10~85 ml;4例中转开腹,其中,1例胆囊与周围组织粘连严重,壶腹部标志消失,与肝十二指肠韧带界限不清,2例胆囊萎缩深陷肝脏内,胆囊三角区瘢痕粘连,1例胆囊管结石嵌顿且严重粘连,术后住院时间8~11 d,术后恢复均良好,治愈出院;80例术后病理诊断,急性单纯性胆囊炎41例(51.2%),急性化脓性胆囊炎24例(30.0%),急性坏疽性胆囊炎15例(18.8%)。结论:经腹腔镜胆总管切开取石T管引流术急诊治疗重症急性胆管炎是可行、有效和安全的治疗方法。 Objective: To evaluate the clinical efficacy of laparoscopic choledocholithotomy with T-tube drainage acute eholangitis of severe type (ACST). Methods: 80 cases of ACST from April 2004 to October 2007 were selected and performed emergency laparoscopic treatment. Results: Among 80 cases of ACST, 76 cases were successfully implemented LC, gallbladder puncture and decompression +choledocholithotomy T-tube drainage were performed in 11 cases, choledocholithotomy T-tube drainage in 15 cases, common bile duct+gall bladder fistula Toishi T-tube drainage in 14 cases, gallbladder removal+choledocholithotomy T-tube drainage in 36 cases, operative time 15-120 min, bleeding 10-80 ml; 4 cases transitted laparotomy, 1 case of gallbladder and surrounding tissue adhesion serious, ampulla signs disappear, and the hepatoduodenal ligament ill-defined, 2 cases of gallbladder contraction deep within the liver, gallbladder triangle scar adhesions, and 1 case of duct stone impaction and severe adhesions; postoperative hospital stay was 8-11 d, all were well recovered; pathological diagnosis, acute eholecystitis in 41 cases (51.2%), acute suppurative cholecystitis in 24 cases (30.0%), acute gangrenous cholecystitis in 15 cases (18.8%). Conclusion: Laparoscopie choledocholithotomy with T-tube drainage is a feasible, effective and safe treatment for patients with ACST.
出处 《中国医药导报》 CAS 2010年第4期167-168,共2页 China Medical Herald
关键词 重症急性胆管炎 胆结石 腹腔镜 Acute cholangitis of severe type Cholelithiasis Laparoscopy
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