腹腔镜复杂类型胆囊切除术的分析体会

万小宇，钱云，姚卫国

（江苏省兴化市第五人民医院普外科，江苏 兴化，225766）

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摘要：

目的 探讨腹腔镜下复杂类型胆囊切除术的手术技巧。方法 回顾性分析2006年1月至2015年12月在本院施行复杂类型胆囊切除术的98例患者的临床资料。结果 89例患者成功施行了腹腔镜胆囊切除术，9 例中转开腹，包括胆囊三角致密 粘连甚至冰冻状3例，Mirizzi 综合征1例，右副肝管伴结石1例，胆管损伤（侧壁伤）1例，胆囊三角区出血镜下止血困难1例，穿刺伤及网膜血管1例，肠梗阻术后粘连严重无法分开1例。患者全部治愈，随访3个月至2年，无其他并发症发生。结论 腹腔镜下复杂类型胆囊切除术中精细解剖胆囊三角是手术成功的关键，防范周围脏器损伤是成功的基础，果断中转开腹是保证手术安全的前提。

关键词：胆囊疾病；腹腔镜复杂胆囊切除术；开腹手术

中图分类号：R657.4文献标志码：A文章编号：2096-1413(2017)05-0153-02

Analysis of complicated laparoscopic cholecystectomy
WAN Xiao-yu, QIAN Yun, YAO Wei-guo
（Department of General Surgery, the Fifth People's Hospital of Xinghua, Xinghua 225766, China）


ABSTRACT: Objective To explore the operative techniques of complicated laparoscopic cholecystectomy. Methods The clinical data of 98 patients with complicated cholecystectomy in our hospital from January 2006 to December 2015 were retrospectively analyzed. Results There were 89 patients were successfully performed laparoscopic cholecystectomy, and 9 cases were converted to open surgery, including 3 cases of dense adhesions and even frozen in the gallbladder triangle, 1 case of Mirizzi's syndrome, 1 case of right accessory hepatic duct with stone, 1 case of bile duct injury (lateral wall injury), 1 cases of difficulty of hemostasis in the triangle area of the gallbladder, 1 case of stab wound and retinal vessels, 1 case of intestinal obstruction after severe adhesions can not be separated. All patients were cured and followed up for 3 months to 2 years, no other complications occurred. Conclusion The key to the success of laparoscopic cholecystectomy is the fine dissection of the gallbladder triangle in laparoscopic cholecystectomy, and to prevent the damage of surrounding organs is the foundation of success, at the same time to decisive conversion to open surgery can ensure the safety of the premise.
KEYWORDS: gallbladder diseases; complicated laparoscopic cholecystectomy operative skills; open surgery

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