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目的探讨腹腔镜技术在治疗急性结石性胆囊炎中的手术指证、手术技巧,并发症的预防与处理。方法回顾性分析2009年1月-2012年7月350例急性结石性胆囊炎的临床资料。结果本组350例急性结石性胆囊炎患者中,329例成功完成LC,成功率为94%;21例因胆囊周围广泛黏连或渗血严重等原因而中转开腹,中转率为6%。术后发生胆漏4例,腹腔引流治愈;胆管损伤2例,术中发现后及时中转开腹,行胆总管修补及T型管引流治愈;术后胆总管残留结石4例,后行ERCP治愈;5例术后脐旁戳孔愈合不良,局部换药后治愈;本组无死亡病例,平均住院时间8d。结论目前腹腔镜技术发展日趋成熟,LC已成为治疗治疗急性胆囊炎、胆囊结石等胆囊相关疾病的“金标准”。只要严格掌握手术适应证,选择适当的手术时机,术中仔细操作,注意技巧,对于急性结石性胆囊炎患者来说,行LC是安全可行的。
Objective To investigate the surgical indications, surgical techniques and complications of laparoscopy in the treatment of acute calcific cholecystitis. Methods The clinical data of 350 cases of acute calculous cholecystitis from January 2009 to July 2012 were retrospectively analyzed. Results Among the 350 patients with acute calcific cholecystitis, 329 patients successfully completed LC with a success rate of 94%. 21 patients were converted to open laparotomy due to extensive adhesions or severe bleeding around the gallbladder, with a conversion rate of 6%. Postoperative biliary leakage in 4 cases, abdominal drainage cure; bile duct injury in 2 cases, intraoperative and timely conversion to open laparotomy, common bile duct repair and T-tube drainage cure; residual bile duct stones after operation in 4 cases, followed by ERCP cure ; 5 cases of postoperative umbilical paraplegia healing, local dressing cure; no deaths in this group, the average length of stay 8d. Conclusions At present, the development of laparoscopic technology is maturing. LC has become the “gold standard” for the treatment of gallbladder-related diseases such as acute cholecystitis and gallstone. As long as strict indications of surgical indications, select the appropriate timing of surgery, intraoperative careful operation, pay attention to skills, for patients with acute calcific cholecystitis, LC is safe and feasible.