CAJ | 학술논문

目的总结急性胆囊炎(AC)施行腹腔镜胆囊切除术(LC)的经验.方法回顾性分析382例AC施行LC患者的临床资料.结果 370例完成了LC,12例即刻中转开腹胆囊切除,中转率3.14%.胆囊切除方法依次为顺行267例、逆行59例、顺逆结合方法44例.均行腹腔引流.术后并发症15例,发生率3.93%,分别为剑突下穿刺孔感染化脓9例、腹腔感染2例、粘连性肠梗阻2例、剑突下切口疝2例.无死亡及医源性损伤发生.结论 AC施行LC以症状发作后72 h内最佳;仔细解剖Calot三角、正确处理胆囊颈或胆囊管结石嵌顿以及增粗变短的胆囊管、防止胆囊动脉损伤和避免过深剥离胆囊床是手术成功的主要措施;及时中转开腹有利于减少和避免并发症及医源性损伤.
목적 총결급성담낭염(AC)시행복강경담낭절제술(LC)적경험.방법 회고성분석382례AC시행LC환자적림상자료.결과 370례완성료LC,12례즉각중전개복담낭절제,중전솔3.14%.담낭절제방법의차위순행267례、역행59례、순역결합방법44례.균행복강인류.술후병발증15례,발생솔3.93%,분별위검돌하천자공감염화농9례、복강감염2례、점련성장경조2례、검돌하절구산2례.무사망급의원성손상발생.결론 AC시행LC이증상발작후72 h내최가;자세해부Calot삼각、정학처리담낭경혹담낭관결석감돈이급증조변단적담낭관、방지담낭동맥손상화피면과심박리담낭상시수술성공적주요조시;급시중전개복유리우감소화피면병발증급의원성손상.
Objective To summarize the experience of laparoscopic cholecystectomy ( LC) for acute cholecystitis (AC).Methods A retrospective study was conducted on 382 patients with AC, who were underwent LC.Results Of all 382 cases,370 cases were successfully finished with LC,and other 12 cases were finished with open surgery(3.14% ).The operation methods are successively anterograde cholecystectomy(267 cases),retrograde cholecystectomy(59 cases) ,anterograde and retrograde cholecystectomy(44 cases).Abdominal drainage was placed in all cases.Post-operation complications occurred in 15 cases (3.93% ).The complications are suppurative infection of sub-ensistemum incision(9 cases) ,abdominal infection(2 cases) ,adhesive ileus(2 cases) ,sub-ensisternum incision hernia(2 cases).There are no death cases,transfusion cases or latrogenic injury in our study.Conclusion The best time window of LC for AC was with in 72 hours since the symptom.The key factors for the surgery were careful dissection of calot's triangle,properly handling with the incarcerated cystic duct stone and thickened cystic duct,avoiding injury of cystic artery and over-dissection of gallbladder bed.Transfer to open surgery when necessary could reduce complications and latrogenic injury.