腹腔镜胆囊大部切除术的临床应用体会（附468 例报告）

Clinical experience of laparoscopic subtotal cholecystectomy (468 cases)

摘要:

目的 探讨腹腔镜胆囊大部切除术的适应证及临床应用体会。方法 回顾性分析2012 年1 月-2015 年12 月解放军第451 医院因无法行腹腔镜胆囊切除术而改为胆囊大部切除术的临床病例资料468 例。 结果 术后无死亡病例发生。7 例行腹腔镜胆囊切除术中转开腹胆囊大部切除术，5 例Mirizzi 综合征（I 型3 例，II 型2 例）和456 例（各种原因导致的三角区粘连）行腹腔镜胆囊大部切除术。术后无严重并发症出现， 16 例出现胆瘘，2 例十二指肠瘘，适当引流后均痊愈。362 例随访时间（21.0±4.9）个月，消化不良18 例，右 上腹或上腹部不适11 例。结论 对于胆囊三角区粘连严重的胆结石患者，腹腔镜下胆囊大部切除术是安全可 行的，可避免对胆道的损伤，术中和术后重点观察患者胆瘘情况。

Abstract:

Objective To investigate the indication and clinical experience of laparoscopic subtotal cholecystectomy. Methods We performed a retrospective analysis on the clinical data of 468 patients who underwent laparoscopic subtotal cholecystectomy from January 2012 to December 2015. Results There were no deaths. 7 cases that underwent laparoscopic cholecystectomy were converted to open surgery with laparoscopic subtotal cholecystectomy. 5 cases that were diagnosed with Mirizzi syndrome (3 cases with type I and 2 with type II) and 456 cases underwent laparoscopic subtotal cholecystectomy. No severe complication was detected after surgery. 16 cases with biliary leakage and 2 with duodenum leakage. The patients got recovered after a short time of drainage. 362 cases were followed up and the median follow-up time was (21.0 ± 4.9) months. 18 ones were with dyspepsia and 11 ones with upper or right upper discomfort. Conclusion Laparoscopic subtotal cholecystectomy was a safe choice and avoided injury of biliary duct for patients with severe adhesion of calot’s triangle. The biliary leakage should be mainly observed during and after surgery.