中华腔镜外科杂志（电子版）
中華腔鏡外科雜誌（電子版）
중화강경외과잡지（전자판）
Chinese Journal of Laparoscopic Surgery (Electronic Edition)
2015年
5期
325-327
,共3页
萎缩性胆囊炎%腔镜胆囊手术%并发症
萎縮性膽囊炎%腔鏡膽囊手術%併髮癥
위축성담낭염%강경담낭수술%병발증
Atrophic cholecystitis%Laparoscopic cholecystectomy%Complication
目的：探讨在行腹腔镜下胆囊切除术时，如果发现为结石性萎缩性胆囊炎，或发现有胆管损伤、胆漏等并发症的预防与处理。方法回顾性分析福建省立医院2006年1月至2012年12月行腹腔镜胆囊切除术时发现的115例结石性萎缩性胆囊炎患者，患者腔镜下操作较为困难，术中探查见胆囊壁炎症明显，胆囊三角明显水肿，解剖关系不清，胆囊萎缩，周围粘连严重；随机将患者分为两组，第一组80例，于腹腔镜下剖开胆囊颈，取出结石，探查分离出胆囊管，夹闭后逆行切除胆囊；第二组35例，行腹腔镜下逆行切除胆囊；观察统计两组中转开腹手术率、手术时间、术中出血、胆管损伤、胆漏等并发症发生率等指标差异是否具有统计学意义。结果第一组与第二组在手术时间、术中出血等指标比较，差异无统计学意义（P＞0．05）；但在中转开腹手术率、胆管损伤、胆漏并发症发生率比较，差异有统计学意义（ P＜0．05）。结论对于腹腔镜术中发现为结石性萎缩性胆囊炎，腹腔镜下剖开胆囊颈、取出结石，探查、夹闭胆囊管后逆行切除胆囊，可减少中转开腹手术率，以及减少胆管损伤、胆漏并发症的出现。
目的：探討在行腹腔鏡下膽囊切除術時，如果髮現為結石性萎縮性膽囊炎，或髮現有膽管損傷、膽漏等併髮癥的預防與處理。方法迴顧性分析福建省立醫院2006年1月至2012年12月行腹腔鏡膽囊切除術時髮現的115例結石性萎縮性膽囊炎患者，患者腔鏡下操作較為睏難，術中探查見膽囊壁炎癥明顯，膽囊三角明顯水腫，解剖關繫不清，膽囊萎縮，週圍粘連嚴重；隨機將患者分為兩組，第一組80例，于腹腔鏡下剖開膽囊頸，取齣結石，探查分離齣膽囊管，夾閉後逆行切除膽囊；第二組35例，行腹腔鏡下逆行切除膽囊；觀察統計兩組中轉開腹手術率、手術時間、術中齣血、膽管損傷、膽漏等併髮癥髮生率等指標差異是否具有統計學意義。結果第一組與第二組在手術時間、術中齣血等指標比較，差異無統計學意義（P＞0．05）；但在中轉開腹手術率、膽管損傷、膽漏併髮癥髮生率比較，差異有統計學意義（ P＜0．05）。結論對于腹腔鏡術中髮現為結石性萎縮性膽囊炎，腹腔鏡下剖開膽囊頸、取齣結石，探查、夾閉膽囊管後逆行切除膽囊，可減少中轉開腹手術率，以及減少膽管損傷、膽漏併髮癥的齣現。
목적：탐토재행복강경하담낭절제술시，여과발현위결석성위축성담낭염，혹발현유담관손상、담루등병발증적예방여처리。방법회고성분석복건성립의원2006년1월지2012년12월행복강경담낭절제술시발현적115례결석성위축성담낭염환자，환자강경하조작교위곤난，술중탐사견담낭벽염증명현，담낭삼각명현수종，해부관계불청，담낭위축，주위점련엄중；수궤장환자분위량조，제일조80례，우복강경하부개담낭경，취출결석，탐사분리출담낭관，협폐후역행절제담낭；제이조35례，행복강경하역행절제담낭；관찰통계량조중전개복수술솔、수술시간、술중출혈、담관손상、담루등병발증발생솔등지표차이시부구유통계학의의。결과제일조여제이조재수술시간、술중출혈등지표비교，차이무통계학의의（P＞0．05）；단재중전개복수술솔、담관손상、담루병발증발생솔비교，차이유통계학의의（ P＜0．05）。결론대우복강경술중발현위결석성위축성담낭염，복강경하부개담낭경、취출결석，탐사、협폐담낭관후역행절제담낭，가감소중전개복수술솔，이급감소담관손상、담루병발증적출현。
Objective To investigate preventive measures against the injury of bile duct and biliary leakage during laparoscopic cholecystectomy for atrophic cholecystitis .Methods The investigation was based on 115 patients of laparoscopic cholecystectomy for atrophic cholecystitis from Jan .2006 to Dec.2012 in our hospital.The patients was divided two groups stochastically .One group comprised 80 patients, which split the collum vesicae biliaris , removed the calculus , disconnectted the cystic duct , ligated it and ectomized the gallbladder retrogradly .The another group comprised 35 patients, which only ectomized the gallbladder retrogradly.To observe whether two groups have statistics difference altered to open the abdominal rate , in operation time, bleeding amount, bile duct injury or bile leaking rate .Results Two groups′have no statistics difference in operation time ,bleeding amount , but have significant statistics difference in altered to open the abdominal rate, bile duct injury, bile leaking rate.Conclusions Laparoscopic cholecystectomy for atrophic cholecystitis split the collum vesicae biliaris , removed the calculus , disconnectted the cystic duct , ligated removed galloladder retrogradly , which can reduce altered to open the abdominal rate , bile duct injury or bile leaking rate.
