CAJ | 학술논문

目的：探讨困难类型腹腔镜胆囊切除围手术期的处理方法及并发症的预防。方法利用回顾性分析临床资料的方法，选择广东省中山大学附属东华医院1999年-2013年10月82例因急性胆囊炎、Mirizzi综合征、腹部手术史伴腹腔严重粘连、萎缩性胆囊炎、合并肝硬化等困难类型腹腔镜胆囊切除术的临床资料，总结经验和教训。结果除6例中转开腹（占7．31％）外，余均用腹腔镜成功完成手术；术后胆道损伤、胆瘘2例，再次手术后治愈；术后出血4例，保守治疗后痊愈；术后不明原因、不同程度胆漏者10例，经引流后自愈。结论对于困难类型腹腔镜胆囊切除术，虽然手术操作难度大，风险高，只要围手术期处理方法适当，仍可以在腹腔镜下完成手术。
목적：탐토곤난류형복강경담낭절제위수술기적처리방법급병발증적예방。방법이용회고성분석림상자료적방법，선택광동성중산대학부속동화의원1999년-2013년10월82례인급성담낭염、Mirizzi종합정、복부수술사반복강엄중점련、위축성담낭염、합병간경화등곤난류형복강경담낭절제술적림상자료，총결경험화교훈。결과제6례중전개복（점7．31％）외，여균용복강경성공완성수술；술후담도손상、담루2례，재차수술후치유；술후출혈4례，보수치료후전유；술후불명원인、불동정도담루자10례，경인류후자유。결론대우곤난류형복강경담낭절제술，수연수술조작난도대，풍험고，지요위수술기처리방법괄당，잉가이재복강경하완성수술。
Objective To investigate perioperative management and the prevention of complications in difficult laparoscopic cholecystecto-my.Methods A retrospective analysis was performed on the clinical data of 82 patients,who underwent difficult laparoscopic cholecystec-tomy due to acute cholecystitis,Mirizzi syndrome,a history of abdominal surgery with severe abdominal adhesion,atrophic cholecystitis,liv-er cirrhosis with gallstones,and other diseases in our hospital since 1999,to summarize the experiences and lessons.Results Among all patients,6 (7.31%)were converted to open laparotomy,and other patients were successfully treated by laparoscopic cholecystectomy. Postoperative biliary injury and biliary fistula occurred in 2 cases,and they were cured after reoperation.Postoperative bleeding occurred in 4 cases,and they were cured with conservative treatment.Different degrees of biliary leak of unknown causes occurred in 10 cases,and they were cured after drainage.Conclusion For difficult laparoscopic cholecystectomy,surgical operation is characterized by high difficulty and high risk,but it can still be completed with proper perioperative management.