CAJ | 학술논문

目的探讨和分析急性结石性胆囊炎患者急性期行腹腔镜胆囊切除术（LC）的临床应用及疗效．方法回顾性分析2008年8月至2012年12月间河南省南阳市医学高等专科学校第一附属医院普通外科及昆明医科大学第二附属医院肝胆胰外三科在急性期实施腹腔镜胆囊切除术治疗急性结石性胆囊炎1353例患者，观察其临床效果．结果1353例患者中1316例完成LC，成功率97.27%，其中胆管损伤1例，腹腔镜下置T管引流后治愈；术后胆漏2例，拔除腹腔引流管后出现温氏孔积液1例，经持续引流后均痊愈．手术时间26～168 min，平均47 min，住院时间3～15 d，平均7.3 d，无切口感染病例．中转开腹37例，其原因：胆总管损伤2例，胆囊三角解剖关系不清23例，胆囊颈部大结石嵌顿致胆囊压力过大，减压后仍操作困难者3例，胆囊结石并胆囊癌2例，萎缩性及瓷化性急性胆囊炎并结石者2例，胆囊动脉出血4例，腹腔严重粘连1例．结论在术者必须熟悉胆囊三角解剖关系，具有娴熟的LC操作技巧的基础上对急性结石性胆囊炎患者急性期行LC具有安全、有效、微创、康复快、费用低等优点.
목적탐토화분석급성결석성담낭염환자급성기행복강경담낭절제술（LC）적림상응용급료효．방법회고성분석2008년8월지2012년12월간하남성남양시의학고등전과학교제일부속의원보통외과급곤명의과대학제이부속의원간담이외삼과재급성기실시복강경담낭절제술치료급성결석성담낭염1353례환자，관찰기림상효과．결과1353례환자중1316례완성LC，성공솔97.27%，기중담관손상1례，복강경하치T관인류후치유；술후담루2례，발제복강인류관후출현온씨공적액1례，경지속인류후균전유．수술시간26～168 min，평균47 min，주원시간3～15 d，평균7.3 d，무절구감염병례．중전개복37례，기원인：담총관손상2례，담낭삼각해부관계불청23례，담낭경부대결석감돈치담낭압력과대，감압후잉조작곤난자3례，담낭결석병담낭암2례，위축성급자화성급성담낭염병결석자2례，담낭동맥출혈4례，복강엄중점련1례．결론재술자필수숙실담낭삼각해부관계，구유한숙적LC조작기교적기출상대급성결석성담낭염환자급성기행LC구유안전、유효、미창、강복쾌、비용저등우점.
Objective To explore the clinical curative effect of laparoscopic cholecystectomy (LC) in treatment of patients with acute calculouscholecystitis in acute stage. Methods We retrospectively analysed the data of 1353 patients with acute calculouscholecystitis in acute stage who received laparoscopic cholecystectomy in Dept.of General Surgery, The First Affiliated Hospital of Nanyang Medical College and Dept.of Hepatopancreatobiliary Surgery 3,The 2nd Affiliated Hospital of Kunming Medical University from August 2008 to December 2012. Results In 1353 patients, 1316 patients were performed LC successfully (97.27%) . One patient was found with bile duct injury and was cured after Laparoscopic T tube drainage. Two patients were found with postoperative bile leakage, one of them was found with wing hole effusion after removal of the abdominal cavity drainage tube, and was cured after continuous drainage. The operation time was 26-168 minutes, with an average of 47 minutes, the hospitalization time was 3-15 days, with an average of 7.3 days. No incision infection was found . 37 patients were transferred to laparotomy because of common bile duct injury in 2 cases, unclear gallbladder triangle in 23 cases, difficult operation after decompression result from high gall bladder pressure caused by big calculus incarceration in the gallbladder neck in 3 cases, gallbladder gallstone disease in 2 cases, atrophic and vitrified acute cholecystitis and biliary calculus in 2 cases, gallbladder artery bleeding in 4 cases and severe abdominal cavity adhesion in 1 case. Conclusion For patients with acute calculous cholecystitis in acute stage, LC is asafe, effective, and minimally invasive treatment method with quick recovery and low cost, but the operator must be familiar with the anatomy of Calot triangle,and has skilled LC operation skills.