CAJ | 학술논문

目的探讨腹腔镜胆囊切除术中胆囊床剥离的危险因素与防范措施.方法对接受腹腔镜胆囊切除术中用传统胆囊床剥离方法完成的490例患者资料进行回顾性分析,同期随机选取500例采用改良腹腔镜胆囊床剥离方法的患者进行前瞻性研究.结果传统方法完成的490例患者中,发生肝中静脉床面属支损伤大出血3例,胆囊动脉后支床面分支出血2例,术后诊断胆囊床胆漏5例,变异右肝门静脉损伤2例,变异右肝管损伤1例.改良胆囊床剥离法完成的500例患者中,无一例发生严重手术并发症,同时解剖观察显示胆囊床胆囊动脉后支床面分支占39.6%(198/500),肝中静脉床面属支占11.2 96(56/500),其分布以胆囊床面右侧居多,床面扩张的迷走胆管占2.2%(11/500),变异裸露右肝管占0.6%(3/500),右肝门静脉分支占0.4%(2/500).结论在腹腔镜胆囊切除术中行胆囊床剥离时存在潜在的手术风险.术中遇意外性损伤,应及时中转开腹.改良腹腔镜胆囊床剥离法有助于防范胆囊床剥离的手术风险.
목적 탐토복강경담낭절제술중담낭상박리적위험인소여방범조시.방법 대접수복강경담낭절제술중용전통담낭상박리방법 완성적490례환자자료진행회고성분석,동기수궤선취500례채용개량복강경담낭상박리방법 적환자진행전첨성연구.결과 전통방법 완성적490례환자중,발생간중정맥상면속지손상대출혈3례,담낭동맥후지상면분지출혈2례,술후진단담낭상담루5례,변이우간문정맥손상2례,변이우간관손상1례.개량담낭상박리법완성적500례환자중,무일례발생엄중수술병발증,동시해부관찰현시담낭상담낭동맥후지상면분지점39.6%(198/500),간중정맥상면속지점11.2 96(56/500),기분포이담낭상면우측거다,상면확장적미주담관점2.2%(11/500),변이라로우간관점0.6%(3/500),우간문정맥분지점0.4%(2/500).결론 재복강경담낭절제술중행담낭상박리시존재잠재적수술풍험.술중우의외성손상,응급시중전개복.개량복강경담낭상박리법유조우방범담낭상박리적수술풍험.
Objective To discuss risk factor and operation guard in dissection of cholecyat from its bed during laparoseopic cholecystectomy.Methods The clinical data of 490 cases of laparoscopic cholecystectomy dissect cholecyst from its bed by traditional method during were retrospectively analyzed and simultaneously perspective study on 500 cases of improved laparoscopic cholecyatectomy dissecting cholecyst from its bed.Results There are 3 cases in hemorrhea due to injuring bed brancha of arteria cystica posterior branch,2 cases in bed brancha of arteria cystica posterior branch haemorrhage,5 cases in postoperative bile leak,2 cases in variant right hepatic portal vein injury,1 case in variant right hepatic duct in the 490 cases of laparoscopic choleeystectomy by traditiorhI method.Using our new technique exposed,and then ligated 39.6%(198/500)bed brancha of arteria cystica posterior branch,11.2% (56/500)bed brancha of venae hepaticae intermediate almost in fight side of cholecyst bed,2.2%(11/500)dilated aberrant bile-duct duct.We separated and then protected 0.6%(3/500)unusual right hepatic duct being exposed,0.4%(2/500)right liver branch of portsl vein.Conclusion There are some larvate risk in isolation of choleeyst from its bed during laparoseopic cholecystectomy.Unexpected injury happen during LC,and it ought tO be open cholecysteetomy The improved method provides a safe,efficiency operative procedure.