海南医学
海南醫學
해남의학
HAINAN MEDICAL JOURNAL
2014年
14期
2145-2146,2147
,共3页
闫北平%郑圣保%国维克%唐斌%王莉%余燕
閆北平%鄭聖保%國維剋%唐斌%王莉%餘燕
염북평%정골보%국유극%당빈%왕리%여연
胆囊切开%复杂%腹腔镜%胆囊切除术
膽囊切開%複雜%腹腔鏡%膽囊切除術
담낭절개%복잡%복강경%담낭절제술
Gallbladder incision%Complex%Laparoscopy%Cholecystectomy
目的:探讨腹腔镜复杂胆囊切除术中胆囊切开引导胆囊管的重要性及处理方法。方法选取50例腹腔镜复杂胆囊切除术患者并按入院顺序随机分为常规组(常规行腹腔镜胆囊切除术)和实验组(术中采用胆囊切开引导胆囊管)各25例,其中实验组先切开胆囊壶部或体部,先将胆汁吸净,将结石取出,辨认胆囊管的开口,采用钛夹夹闭胆囊管(胆囊管可完全分离)或于腹腔镜下缝扎胆囊管断端(胆囊管紧贴胆总管难以分离)。观察两组患者手术情况及肝外胆管损伤发生率。结果两组患者术后均无切口感染、腹腔感染及出血等并发症的发生,术后引流2~3 d,常规组患者中1例引流出胆汁样液体,延长引流时间至1周。实验组手术时间、术中出血量、住院时间、住院费用、引流量及肝外胆管损伤均低于常规组,两组比较差异具有统计学意义(P<0.05)。结论复杂腹腔镜胆囊切除术中采用胆囊切开引导胆囊管可明显降低手术难度,缩短手术时间,减少手术创伤,且具有较好的安全性和可行性。
目的:探討腹腔鏡複雜膽囊切除術中膽囊切開引導膽囊管的重要性及處理方法。方法選取50例腹腔鏡複雜膽囊切除術患者併按入院順序隨機分為常規組(常規行腹腔鏡膽囊切除術)和實驗組(術中採用膽囊切開引導膽囊管)各25例,其中實驗組先切開膽囊壺部或體部,先將膽汁吸淨,將結石取齣,辨認膽囊管的開口,採用鈦夾夾閉膽囊管(膽囊管可完全分離)或于腹腔鏡下縫扎膽囊管斷耑(膽囊管緊貼膽總管難以分離)。觀察兩組患者手術情況及肝外膽管損傷髮生率。結果兩組患者術後均無切口感染、腹腔感染及齣血等併髮癥的髮生,術後引流2~3 d,常規組患者中1例引流齣膽汁樣液體,延長引流時間至1週。實驗組手術時間、術中齣血量、住院時間、住院費用、引流量及肝外膽管損傷均低于常規組,兩組比較差異具有統計學意義(P<0.05)。結論複雜腹腔鏡膽囊切除術中採用膽囊切開引導膽囊管可明顯降低手術難度,縮短手術時間,減少手術創傷,且具有較好的安全性和可行性。
목적:탐토복강경복잡담낭절제술중담낭절개인도담낭관적중요성급처리방법。방법선취50례복강경복잡담낭절제술환자병안입원순서수궤분위상규조(상규행복강경담낭절제술)화실험조(술중채용담낭절개인도담낭관)각25례,기중실험조선절개담낭호부혹체부,선장담즙흡정,장결석취출,변인담낭관적개구,채용태협협폐담낭관(담낭관가완전분리)혹우복강경하봉찰담낭관단단(담낭관긴첩담총관난이분리)。관찰량조환자수술정황급간외담관손상발생솔。결과량조환자술후균무절구감염、복강감염급출혈등병발증적발생,술후인류2~3 d,상규조환자중1례인류출담즙양액체,연장인류시간지1주。실험조수술시간、술중출혈량、주원시간、주원비용、인류량급간외담관손상균저우상규조,량조비교차이구유통계학의의(P<0.05)。결론복잡복강경담낭절제술중채용담낭절개인도담낭관가명현강저수술난도,축단수술시간,감소수술창상,차구유교호적안전성화가행성。
Objective To explore the importance and treatment of the guide to the cystic duct through gall-bladder incision in the complex laparoscopic cholecystectomy. Methods Fifty patients underwent the complicated laparoscopic cholecystectomy were randomly divided into routine group (routine laparoscopic cholecystectomy) and experimental group (patients with gallbladder incision guided cystic duct), with 25 cases in each group. In the experi-mental group, gallbladder ampulla or body part was incised, and the bile was absorbed, and then the calculus of cystic duct was removed and the opening was recognized. If gallbladder tube can be completely separated, the titanium clip-ping was used;if the common bile duct cystic duct is difficult to separate, laparoscopic suture of cystic duct stump was employed. The operation efficacy and extrahepatic bile duct injury rate were observed in two groups. Results The patients in two groups had no abdominal infection, bleeding complications and incision infection, and drainage was re-move 2~3 d after operation. One case in the routine group occurred drainage bile sample liquid, and drainage time was prolorged to 1 week. In experimental group, operation time, amount of bleeding, hospitalization time and cost, drainage and extrahepatic bile duct injury were lower than those in the routine group (all the P<0.05). Conclusion The com-plex laparoscopic cholecystectomy gallbladder incision guided by the cystic duct can significantly reduce the difficul-ty of operation, shorten operation time and reduce the operation trauma, with safety and applicability.