不保留胆囊管的腹腔镜胆囊切除术

发布时间：2018-04-08 07:33

本文选题：胆囊切除术　切入点：腹腔镜　出处：《中国微创外科杂志》2017年04期

【摘要】：目的探讨不保留胆囊管的腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的安全性、可行性及临床效果。方法回顾性分析2013年3月~2016年1月321例LC的临床资料。采取三孔或四孔法LC,首先解剖出胆总管、胆囊管、肝总管及胆囊动脉"四管"结构;充分游离胆囊管近肝总管汇入部;确认无胆囊管结石后,于近肝总管处夹闭胆囊管并切除胆囊。结果 312例(97.2%)顺利完成不保留胆囊管LC;9例(2.8%)保留0.5 cm~全长胆囊管,包括肝管变异1例(中转开腹),胆囊管汇入点异常4例,萎缩性胆囊炎三角区解剖困难3例,急性坏疽性胆囊炎1例。均无术中胆管损伤、术后胆漏及腹腔大出血等严重并发症。术后随访1~40个月,(23.3±11.0)月,312例不保留胆囊管LC术后无胆管狭窄、胆道残余结石、腹痛、黄疸等表现;9例保留胆囊管病例中,2例术后反复上腹部隐痛症状,未发现结石残留或结石复发。结论不保留胆囊管LC安全、可行,可防止残余小胆囊,避免胆囊管残余结石。
[Abstract]:Objective to investigate the safety, feasibility and clinical effect of laparoscopic cholecystectomy without preserving the duct of gallbladder.Methods the clinical data of 321 cases of LC from March 2013 to January 2016 were retrospectively analyzed.The gallbladder duct was clamped near the common hepatic duct and the gallbladder was excised.Results 312 cases (97.2%) successfully completed the preservation of 0.5 cm ~ full-length gallbladder duct, including 1 case of hepatic duct variation (conversion to laparotomy, 4 cases of abnormal convergent point of gallbladder duct, 3 cases of anatomic difficulties in the triangle area of atrophic cholecystitis).One case of acute gangrenous cholecystitis.There were no serious complications such as bile duct injury, postoperative bile leakage and abdominal hemorrhage.Follow-up for 1 to 40 months (23.3 卤11.0) months after operation, 312 cases without cholecystic duct LC without bile duct stenosis, residual bile duct stones, abdominal pain, jaundice, etc., were followed up for 1 to 40 months.No stone residue or recurrence was found.Conclusion it is safe and feasible to avoid residual small gallbladder and residual gallstone without retaining LC of gallbladder duct.
【作者单位】：南京医科大学附属常州第二人民医院肝胆外科;
【基金】：常州市高层次卫生人才培养工程(项目编号:2016CZLJ007)
【分类号】：R657.4

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