CAJ | 학술논문

目的：探讨复杂性胆囊腹腔镜胆囊切除术（LC）的方法。方法回顾分析2007年8月至2013年11月我科收治的81例复杂胆囊病患者的临床资料，其中急性胆囊炎66例，萎缩胆囊炎14例，Mirizzi综合征1例。所有腹腔镜手术在使用吸引器刮吸分离与超声刀切割相结合下完成。手术历时1．5～3 h不等。结果79例LC手术成功完成，手术中1例肝总管损伤在腔镜下缝合修补，1例术中出血中转开腹手术，1例术前怀疑Mirizzi综合征，手术中确诊中转开腹手术。结论腹腔镜复杂性胆囊切除术安全可行。成功的关健是术前对病例进行认真讨论，术中使用吸引器与超声刀解剖Calot三角，胆囊切除采取顺行与逆行结合，全部切除与部分切除相结合，有效地避免术中大出血和胆管损伤，使腹腔镜下复杂性胆囊切除变得安全可靠。
목적：탐토복잡성담낭복강경담낭절제술（LC）적방법。방법회고분석2007년8월지2013년11월아과수치적81례복잡담낭병환자적림상자료，기중급성담낭염66례，위축담낭염14례，Mirizzi종합정1례。소유복강경수술재사용흡인기괄흡분리여초성도절할상결합하완성。수술력시1．5～3 h불등。결과79례LC수술성공완성，수술중1례간총관손상재강경하봉합수보，1례술중출혈중전개복수술，1례술전부의Mirizzi종합정，수술중학진중전개복수술。결론복강경복잡성담낭절제술안전가행。성공적관건시술전대병례진행인진토론，술중사용흡인기여초성도해부Calot삼각，담낭절제채취순행여역행결합，전부절제여부분절제상결합，유효지피면술중대출혈화담관손상，사복강경하복잡성담낭절제변득안전가고。
Objective To investigate the approach to laparoscopic cholecystectomy (LC)in the treatment of complicated gallbladder dis-ease.Methods A retrospective analysis was performed on the clinical data of 81 patients with complicated gallbladder disease admitted to the Department of General Surgery in our hospital from August 2007 to November 2013,including 66 cases of acute cholecystitis,14 cases of atrophic cholecystitis,and 1 case of Mirizzi syndrome.All laparoscopic operations were completed using the aspirating dissector and ultrason-ic knife and lasted for 1 .5 -3 h.Results LC was successfully completed in 79 cases.One case had common hepatic duct injury during op-eration,which was treated by laparoscopic suture repair;one case had intraoperative bleeding and was converted to laparotomy;one case was suspected of having Mirizzi syndrome before operation and was converted to laparotomy after the syndrome was confirmed during operation. Conclusion Laparoscopic cholecystectomy is safe and feasible in the treatment of complicated gallbladder disease.The key to successful treatment is preoperative evaluation of this disease,intraoperative use of aspirating dissector and ultrasonic knife for dissecting the Calot tri-angle,antegrade resection combined with retrograde resection,and total resection combined with partial resection,which can effectively a-void intraoperative hemorrhage and bile duct injury.