Laparoscopic cholecystectomy for acute cholecystitis: clinical analysis of 216 cases
-
摘要: 目的探讨腹腔镜胆囊切除术(LC)治疗急性胆囊炎的临床经验。方法回顾性分析复旦大学附属中山医院青浦分院2010年1月-2013年1月行LC的216例急性胆囊炎患者临床资料。手术采用气管插管全麻,常规采用三孔法,必要时增加一戳孔以利于操作。术后引流管放置13 d,使用抗生素35 d。观察手术时间、术后住院时间及术后并发症发生率。术后所有患者均随访至少半年。结果本组LC成功率87.0%(188/216),中转开腹率13.0%(28/216),平均手术时间(62.00±11.27)min,平均住院时间(4.60±2.16)d,并发症发生率2.3%(5/216),患者均痊愈出院。随访期间均无其他并发症发生,术后恢复均良好。结论腹腔镜胆囊切除术治疗急性胆囊炎是安全可行的,正确处理好胆囊三角及良好的术中引流是手术成功的关键。Abstract: Objective To investigate the clinical experience of laparoscopic cholecystectomy (LC) for acute cholecystitis. Methods A retrospective analysis was performed on the clinical records of 216 patients with acute cholecystitis who underwent LC in Qingpu Branch of Zhongshan Hospital, Fudan University from January 2010 to January 2013. LC was performed under intubation general anaesthesia, with three holes conventionally and four holes if necessary. After operation, the drainage tube was placed for 1- 3 d, and antibiotics were administered for 3-5 d. The time of operation, length of postoperative hospital stay, and incidence of postoperative complications were determined. All patients were followed up for at least 0. 5 year after operation. Results LC was successfully performed in 188 (87. 0%) of all patients; 28 (13. 0%) of all patients were converted to open surgery. The mean time of operation was 62. 00 ± 11. 27 min; the mean length of hospital stay was 4. 60± 2. 16 d; the incidence of postoperative complications was 2. 3% (5 /216) . All patients were cured and discharged. During follow- up, no patients developed other complications and all recovered well. Conclusion LC is safe and feasible in the treatment of acute cholecystitis. Correct manipulation of the Calot's triangle and proper abdominal drainage are the key to successful operation.
-
Key words:
- cholecystectomy, laparoscopic /
- cholecystitis, acute
-
[1]YU AJ, ZHAO HT, ZHAO LW, et al.Analysis of causes for immediate conversion to laparotomy during laparoscopic cholecystectomyin patients with acute cholecystitis[J].J Med Res, 2012, 41 (4) :173-174, 181. (in Chinese) 于爱军, 赵洪清, 赵鲁文, 等.急性胆囊炎腹腔镜手术即刻中转开腹原因分析[J].医学研究杂志, 2012, 41 (4) :173-174, 181. [2]XU CD, CHEN XM, LA X.Analysis on the safety of three ducts and one pouch in laparoscopic cholecystectomy[J].Chin J Bases Clin General Surg, 2013, 20 (6) :666-667. (in Chinese) 徐成栋, 陈晓明, 喇旭.三管一壶腹在腹腔镜胆囊切除术中的安全性分析[J].中国普外基础与临床杂志, 2013, 20 (6) :666-667. [3]OHTA M, IWASHITA Y, YADA K, et al.Operative timing of laparoscopic cholecystectomy for acute cholecystitis in a Japanese institute[J].JSLS, 2012, 16 (1) :65-70. [4]LAU H, LO CY, PATIL NG, et al.Early versus delayed-interval laparoscopic cholecystectomy for acute cholecystitis:a meta-analysis[J].Surg Endosc, 2006, 20 (1) :82-87. [5]ASAI K, WATANABE M, KUSACHI S, et al.Changes in the therapeutic strategy for acute cholecystitis after the Tokyo guidelines were published[J].J Hepatobiliary Pancreat Sci, 2013, 20 (3) :348-355. [6]HIROTA M, TAKADA T, KAWARADA Y, et al.Diagnostic criteria and severity assessment of acute cholecystitis:Tokyo Guidelines[J].J Hepatobiliary Pancreat Surg, 2007, 14 (1) :78-82. [7]YAMASHITA Y, TAKADA T, STRASBERG SM, et al.TG13 surgical management of acute cholecystitis[J].J Hepatobiliary Pancreat Sci, 2013, 20 (1) :89-96. [8]HUANG JF.Hepatobiliary and pancreatic surgery[M].4 version.Beijing:People's Medical Publishing House, 2011:520-521. (in Chinese) 黄洁夫, 主译.肝胆胰外科学[M].4版.北京:人民卫生出版社, 2011:520-521. [9]XU JJ, SONG B, ZHANG B, et al.Assessment of Calot's triangle before laparoscopic cholecystectomy with MR cholangiopancreatography:optimization of the examination program[J].Chin J Med Imaging Technol, 2012, 28 (2) :322-327. (in Chinese) 徐晶晶, 宋彬, 张蓓, 等.腹腔镜胆囊切除术前磁共振胰胆管成像显示胆囊三角的检查方案优化探讨[J].中国医学影像技术, 2012, 28 (2) :322-327. [10]STRASBERG SM, HERTL M, SOPER NJ.An analysis of the problem of biliary injury during laparoscopic cholecystectomy[J].J Am Coll Surg, 1995, 180 (1) :101-125. [11]LAU WY, LAI EC, LAU SH.Management of bile duct injury after laparoscopic cholecystectomy:a review[J].ANZ J Surg, 2010, 80 (1-2) :75-81. [12]WU YV, LINEHAN DC.Bile duct injuries in the era of laparoscopic cholecystectomies[J].Surg Clin North Am, 2010, 90 (4) :787-802. [13]WANG QS.Mechanism and prevention for complications of laparoscopic cholecystectomy[J].J Clin Hepatol, 2012, 28 (1) :11-13. (in Chinese) 王秋生.腹腔镜胆囊切除术并发症的发生机制与预防对策[J].临床肝胆病杂志, 2012, 28 (1) :11-13.
本文二维码
计量
- 文章访问数: 2639
- HTML全文浏览量: 13
- PDF下载量: 514
- 被引次数: 0