CAJ | 학술논문

目的探讨急性胆囊炎延期腹腔镜胆囊切除术(LC)的手术技巧及并发症预防.方法将2004年2月至2008年8月收治的133例急性胆囊炎行LC患者,按急性胆囊炎发作后手术治疗的时间分为两组:急性发作72 h内手术的为早期组(34例)和急性发作72 h后手术的延期组(99例).手术技巧是沿胆囊壶腹分离胆囊管,尽量充分“掏空”、显露Calot三角,顺行切除胆囊；如Calot三角粘连紧密,解剖关系不清,可逆性切除胆囊或自壶腹部行胆囊大部切除术.延期组手术难度增大主要集中在Calot三角的处理上.结果 133例全部完成LC手术,无中转开腹,无胆道损伤及胆漏等并发症,无术后30 d再入院.顺行切除术127例,逆行切除术2例,胆囊大部切除术4例.延期组较早期组LC手术时间延长[(44.1±5.32)min比(66.4±3.05) min,P＜0.01]；两组切口感染率比较差异无统计学意义(2.94％比2.02％,P＞0.05).结论延期LC较早期LC难度增大,但同样安全可行；把握好LC的手术技巧和熟练的技术是预防并发症的关键所在.
목적 탐토급성담낭염연기복강경담낭절제술(LC)적수술기교급병발증예방.방법 장2004년2월지2008년8월수치적133례급성담낭염행LC환자,안급성담낭염발작후수술치료적시간분위량조:급성발작72 h내수술적위조기조(34례)화급성발작72 h후수술적연기조(99례).수술기교시연담낭호복분리담낭관,진량충분“도공”、현로Calot삼각,순행절제담낭；여Calot삼각점련긴밀,해부관계불청,가역성절제담낭혹자호복부행담낭대부절제술.연기조수술난도증대주요집중재Calot삼각적처리상.결과 133례전부완성LC수술,무중전개복,무담도손상급담루등병발증,무술후30 d재입원.순행절제술127례,역행절제술2례,담낭대부절제술4례.연기조교조기조LC수술시간연장[(44.1±5.32)min비(66.4±3.05) min,P＜0.01]；량조절구감염솔비교차이무통계학의의(2.94％비2.02％,P＞0.05).결론 연기LC교조기LC난도증대,단동양안전가행；파악호LC적수술기교화숙련적기술시예방병발증적관건소재.
Objective To investigate the technical difficulties and the avoidance of complications in delayed laparoscopic cholecystectomy (LC) for acute cholecystitis (AC).Methods The results of LC carried out on 133 consecutive patients with AC between February 2004 and August 2008 were retrospectively studied.The outcomes were compared between patients who received LC for AC within 72 hours (the early group) and those after 72 hours (the delayed group).There were 34 patients in the early group and 99 in the delayed group.During LC,Calot's triangle was carefully dissected,and the relationship of the cystic duct to the CBD and common hepatic duct was clearly identified.Retrograde cholecystectomy in 2 patients was used when the Calot's triangle was poorly identified.Laparoscopic subtotal cholecystectomy was carried out in 4 patients whose inflammation or fibrosis precluded dissection of the Calot's triangle.Results There was no conversion to open cholecystectomy,biliary tract injury,biliary leak,or any other intraoperative or postoperative complications.There was no 30day readmission in the 2 groups.Patients who received delayed LC had a significantly longer operation time [(44.1±5.32) vs (66.4±3.05)rnin,P＜0.01].There was no significant difference in wound infection rates in the 2 groups (1/34 2.94 ％ vs 2/99 2.02 ％,P＞0.05).Conclusions Delayed LC was as feasible and safe as early LC in the treatment of AC.Delayed LC was technically more demanding than early LC.