论文部分内容阅读
目的探讨电凝吸引器钝性分离法在重症急性胆囊炎早期腹腔镜胆囊切除术中的应用价值。方法对2008年3月～2009年7月56例诊断为重症急性胆囊炎患者在四孔法腹腔镜下应用电凝吸引器钝性分离法处理胆囊三角及从胆囊床上分离胆囊,记录出血量、手术时间、中转开腹率,术后腹腔积液、脓肿,肺部并发症及合并心脑疾患、糖尿病并发症,出院后随访有无胆囊床积液及胆道狭窄等并发症。结果手术时间35～110(62.7±16.7)min,出血量40～200(80.2±40.5)ml。无中转开腹手术及胆道损伤、胆漏,无明显腹腔积液、脓肿,无严重肺部并发症,围手术期未发生脑梗死或脑出血,5例冠状动脉支架置入者无心绞痛、心肌梗死及心律失常。术后随访2～3个月,无发热、腹痛及黄疸,影像学检查无胆囊窝血肿、积液以及胆道狭窄等并发症。结论电凝吸引器钝性分离法治疗重症急性胆囊炎安全有效,值得临床推广。
Objective To investigate the value of blunt dissection of electrocoagulation aspiration in early laparoscopic cholecystectomy for severe acute cholecystitis. Methods From March 2008 to July 2009, 56 cases of severe acute cholecystitis diagnosed as severe acute cholecystitis were treated with blunt dissection of the electrocoagulation aspirator and laparoscopic separation of the gallbladder from the gallbladder bed, Operation time, conversion rate to laparotomy, postoperative ascites, abscess, pulmonary complications and combined cardiovascular and cerebrovascular diseases, complications of diabetes and follow-up of complications such as gallbladder bed fluid and biliary stricture after discharge. Results The operation time ranged from 35 to 110 (62.7 ± 16.7) min and the bleeding volume was 40 to 200 (80.2 ± 40.5) ml. No transit laparotomy and biliary tract injury, bile leakage, no significant ascites, abscess, no serious pulmonary complications, no perioperative cerebral infarction or cerebral hemorrhage, coronary angioplasty in 5 patients without angina, myocardial Infarction and arrhythmia. All patients were followed up for 2 to 3 months. No fever, abdominal pain and jaundice were found. Imaging complications such as gallbladder hematoma, effusion and biliary stricture were observed. Conclusions The blunt dissection method of electrocoagulation aspiration is safe and effective in the treatment of severe acute cholecystitis, which is worthy of clinical promotion.