Clinical analysis of combined antegrade and retrograde technique of laparoscopic cholecystectomy in prevention of bile duct injury
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摘要:
目的:探讨腹腔镜顺逆结合胆囊切除术预防胆管损伤并发症的临床价值。方法:回顾性分析1991年3月—2006年6月间腹腔镜顺逆结合胆囊切除术613例的临床资料。结果:613例中胆囊结石伴胆囊萎缩121例,急性、亚急性胆囊炎432例,胆囊结石伴慢性胆囊炎42例,胆囊息肉18例。中转开腹9例,(5例为胆囊结石伴胆囊萎缩,4例亚急性胆囊炎)。平均手术时间43.5 min ,术后仅1例发生毛细胆管漏,经引流3d痊愈,其余患者均顺利恢复,无胆管损伤病例,无出血、感染及死亡等严重并发症发生。平均术后住院日5.5 d。结论:腹腔镜顺逆结合胆囊切除术能提高腹腔镜胆囊切除术的成功率,减少了腹腔镜胆囊切除术胆管损伤并发症的发生,特别是Calot三角解剖不清或变异时,此手术方法更有效。
Abstract:
Abstract:Objective:To discuss the clinical value of combined antegrade and retrograde technique of laparoscopic cholecystectomy in prevention of bile duct injury. Methods:Clinical data of 613 patients who underwent laparoscopic cholecystectomy with combined antegrade and retrograde technique from March 1991 to June 2006 were analyzed retrospectively. Results:Cholecystolithiasis with atrophy of gallbladder was found in 121 cases, acute and subacute cholecystitis in 432 cases, cholecystolithiasis with chronic cholecystitis in 42 cases and polyps of cholecyst in 18 cases. Nine cases were converted to laparotomy(5 cases of cholecystolithiasis with atrophy of gallbladder and 4 cases of subacute cholecystitis). The average operation time was 43.5 minutes. Bile leakage occured in only 1 case after operation and fully recovered after 3 days of drainage, and all the other cases had smooth recovery with no bile duct injuries or serious complications such as haemorrhage, infection or death. The mean hospitalization time after operation was 5.5 days. Conclusions:The application of combined antegrade and retrograde technique can increase the success rate of laparoscopic cholecystectomy,and reduce the incidence of injuries of bile duct,especially in those patients with inadequate exposure or anatomical variation of Calot′s triangle.