文档介绍：305例胆囊横断法在微创开腹胆囊手术中应用体会
(作者:___________单位: ___________邮编: ___________)
作者:廖忠,郑柳,李文桃,张光全
【摘要】目的探讨胆囊横断法在微创开腹胆囊手术中应用的可行性及临床价值。方法回顾性分析305例急性期重症胆囊炎患者采用胆囊横断法完成手术的临床资料。结果微创开腹完成胆囊切除286例,延长切口19例(%),胆漏14例,胆道损伤1例。胆囊化脓坏疽87例(%),Mirizzi综合征35例(%),胆囊穿孔7例(%),感染中毒性休克6例,胆总管探查23例(%),手术并发症27例(%),无死亡病例。结论微创开腹胆囊手术中,急性重症胆囊炎采用胆囊横断法切除胆囊较为安全,具有临床应用价值。
【关键词】胆囊横断;微创开腹;重症胆囊炎
Abstract: Objective To evaluate the feasibility and clinical value of gallbladder transection in minimally invasive laparotomy cholecystectomy. Methods Clinical data of 286 severe acute cholecystitis cases with the operation of gallbladder transection in minimally invasive open cholecystectomy was retrospectively analyzed. Results There were 19(%)cases extended incision, 14 cases with bile leakage, one case with bile duct injury, 87(%)cases with gangrene of gallbladder, 35( %)cases with Mirizzi syndrome,7(%)cases with gallbladder Perforation, 6 cases with toxic shock, 27(%)cases with plication, and with no died case. Conclusion The gallbladder transection is safe in minimally invasive open cholecystectomy of severe acute cholecystitis.
Keywords: gallbladder transection; minimally invasive laparotomy; cholecystectomy
微创开腹胆囊切除手术一般采用顺行切除胆囊,或顺加逆行切除胆囊,即顺逆结合,其优点是三角区解剖清晰、不易发生损伤、胆囊容易剥离,但在急性重症胆囊炎时胆囊壁增厚大于8 mm、胆囊高张力,预测微创开腹胆囊手术比较困难,采用常规手法不能保证安全切除胆囊[12]。作者采用胆囊横断法,不延长切口达到切除胆囊目的。2005年1月至2009年1月我院在305例微创