中国医学创新
中國醫學創新
중국의학창신
MEDICAL INNOVATION OF CHINA
2014年
25期
146-148
,共3页
坏疽重症性胆囊炎%两操作孔%腹腔镜胆囊切除术%策略
壞疽重癥性膽囊炎%兩操作孔%腹腔鏡膽囊切除術%策略
배저중증성담낭염%량조작공%복강경담낭절제술%책략
Suppurative and serious cholecystitis%Two operation holes%Cholecystectomy with laparoscope%Strategy
目的：在胆囊病变急性发作致胆囊坏疽、重症胆囊炎情况下，探讨腹腔镜两操作孔下胆囊切除的处理策略。方法：四步法进行坏疽、重症胆囊切除：先行胆囊与周围粘连的分离，了解Calot三角关系或重要内容行程；再行胆囊减压，抽吸全部液体性内容；近哈氏袋切开胆囊管周浆膜，用吸引器刮吸胆囊管，致胆囊管和胆囊动脉显露；最后近胆囊壁快速电切分离胆囊床，纱布填压胆囊床及止血。结果：35例患者均成功在两操作孔下完成胆囊切除手术，有5例行胆道造影术，3例行腹腔镜联合胆道镜胆总管切开取石术，术中出血30~650 mL，时间50~130 min。结论：急性坏疽、重症胆囊炎行腹腔胆囊切除手术具有操作难度，表现为胆囊高度充血水肿、肿大积液、易出血和解剖不清，与普通LC术方式上有异常；因重要解剖胆囊管只是轻中度炎症感染，故对有经验的腹腔镜操作者，尽管胆囊存在重症感染，仍可行两操作孔腹腔镜胆囊切除术。
目的：在膽囊病變急性髮作緻膽囊壞疽、重癥膽囊炎情況下，探討腹腔鏡兩操作孔下膽囊切除的處理策略。方法：四步法進行壞疽、重癥膽囊切除：先行膽囊與週圍粘連的分離，瞭解Calot三角關繫或重要內容行程；再行膽囊減壓，抽吸全部液體性內容；近哈氏袋切開膽囊管週漿膜，用吸引器颳吸膽囊管，緻膽囊管和膽囊動脈顯露；最後近膽囊壁快速電切分離膽囊床，紗佈填壓膽囊床及止血。結果：35例患者均成功在兩操作孔下完成膽囊切除手術，有5例行膽道造影術，3例行腹腔鏡聯閤膽道鏡膽總管切開取石術，術中齣血30~650 mL，時間50~130 min。結論：急性壞疽、重癥膽囊炎行腹腔膽囊切除手術具有操作難度，錶現為膽囊高度充血水腫、腫大積液、易齣血和解剖不清，與普通LC術方式上有異常；因重要解剖膽囊管隻是輕中度炎癥感染，故對有經驗的腹腔鏡操作者，儘管膽囊存在重癥感染，仍可行兩操作孔腹腔鏡膽囊切除術。
목적：재담낭병변급성발작치담낭배저、중증담낭염정황하，탐토복강경량조작공하담낭절제적처리책략。방법：사보법진행배저、중증담낭절제：선행담낭여주위점련적분리，료해Calot삼각관계혹중요내용행정；재행담낭감압，추흡전부액체성내용；근합씨대절개담낭관주장막，용흡인기괄흡담낭관，치담낭관화담낭동맥현로；최후근담낭벽쾌속전절분리담낭상，사포전압담낭상급지혈。결과：35례환자균성공재량조작공하완성담낭절제수술，유5례행담도조영술，3례행복강경연합담도경담총관절개취석술，술중출혈30~650 mL，시간50~130 min。결론：급성배저、중증담낭염행복강담낭절제수술구유조작난도，표현위담낭고도충혈수종、종대적액、역출혈화해부불청，여보통LC술방식상유이상；인중요해부담낭관지시경중도염증감염，고대유경험적복강경조작자，진관담낭존재중증감염，잉가행량조작공복강경담낭절제술。
Objective: An acute attack of cholecystopathy can cause gallbladder abscess or gangrene, to discusses the strategies for treatment of inflammatory infection of severe acute cholecystopathy through two operation holes.Method: There were four steps in LC. The first step was to separate cholecyst from the adhesions around to have a preliminary understanding of Calot triangle or important content, when the cholecyst was under tension. Then, an artificial window to be opened in the cholecyst wall, and a pressure-relief aspirator to be placed into it to aspirate all the liquid content. The third step was to cut the serosa of the cystic duct near the Hartmann’s pouch, and to use an aspirator to aspirate the cystic duct until the cystic duct and the cystic artery reveal. The fourth step was to separate the cholecyst bed by electrotomy near the cholecyst wall quickly, and to press immediately the cholecyst bed with gauze. The last step was to stop bleeding from top to bottom. Result: All 35 cases of cholecystectomy through two holes were successful. 5 cases were under cholangiography. 3 cases were operated together with Choledochoscope Choledocholithotomy. During the operation, bleeding was 30-650 mL, time was about 50-130 minutes. Conclusion: The operation of cholecystectomy of suppurative and serious cholecystitis is different from normal LC in the aspects of method and program, in expression of high swelling, lard-bucket, esay bleeding, blurring of anatomy. The inflammatory infection of cystic duct is moderate. Although it may cause severe infection, for an experienced laparoscopic operator, cholecystectomy with laparoscope can be used.
