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目的探讨腹腔镜胆囊切除术治疗急性坏疽性胆囊炎的可行性及手术技巧。方法回顾分析2004年9月-2014年8月经腹腔镜胆囊切除术治疗急性坏疽性胆囊炎的89例患者的临床资料。结果 89例患者中,83例顺利行腹腔镜胆囊切除术,6例中转开腹,中转开腹率6.74%。83例顺利行腹腔镜胆囊切除术的患者手术时间60~150 min,平均120 min;顺行切除45例,逆行切除20例,顺行逆行结合切除18例;术中胆囊穿刺减压78例,胆囊坏疽穿孔处减压5例;72例Calot三角瘢痕样致密粘连,吸引器钝性分离解剖Calot三角65例,横断胆囊壶腹部或壶腹部前后贯通逆行分离胆囊颈管13例,剖开胆囊协助分离胆囊颈管5例,残留胆囊床部分胆囊壁的胆囊切除15例;1例术后发生胆漏经引流后痊愈,1例脐部戳孔感染。术后平均住院时间4 d。结论术中胆囊减压,保持术野清晰,灵活应用吸引器钝性分离,顺行逆行分离结合,胆囊壶腹部前后贯通或离断等多种手术技巧,有利于提高急性坏疽性胆囊炎行腹腔镜胆囊切除术的安全性。
Objective To investigate the feasibility and surgical technique of laparoscopic cholecystectomy in the treatment of acute gangrenous cholecystitis. Methods The clinical data of 89 patients who underwent laparoscopic cholecystectomy for acute gangrenous cholecystitis from September 2004 to August 2014 were retrospectively analyzed. Results Of the 89 patients, 83 were successfully treated with laparoscopic cholecystectomy, 6 were converted to open surgery, and the rate of laparotomy was 6.74%. 83 cases of patients undergoing laparoscopic cholecystectomy surgery time 60 ~ 150 min, an average of 120 min; 45 cases of antegrade resection, retrograde resection in 20 cases, retrograde retrospective and combined resection in 18 cases; intraoperative gallbladder puncture 78 cases of decompression, Gallbladder gangrene perforation Department of decompression in 5 cases; 72 cases of Calot triangle scar-like adhesions, blunt dissection of the suction device Calot triangle 65 cases, transverse ampullary or ampulla of the gallbladder through the retrograde retrograde gallbladder neck before and after 13 cases of gallbladder assistance 5 cases of gallbladder neck separation, residual gallbladder bed cholecystectomy gallbladder in 15 cases; 1 case of bile leakage after drainage healed, 1 case of umbilical poking hole infection. The average postoperative hospital stay was 4 days. Conclusions Intraoperative gallbladder decompression, to maintain a clear operative field, flexible use of suction blunt dissection, retrograde retrograde combination of gallbladder ampulla before and after through a variety of surgical techniques, is conducive to the improvement of acute gangrenous cholecystitis abdominal abdomen Mirror cholecystectomy safety.