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醫(yī)學免費論文:腹腔鏡膽囊切除術治療萎縮性膽囊炎40例體會
【摘要】 目的 探討腹腔鏡膽囊切除術(laparoscopic cholecystectomy,LC)治療萎縮性膽囊炎的技巧。方法 回顧分析我院2006～2008年腹腔鏡膽囊切除術治療萎縮性膽囊炎40例。結果 37例患者成功完成腹腔鏡膽囊切除術,3例中轉開腹,其中2例是因為膽囊三角解剖不清,1例術中肝總管損傷。2例術后出現膽漏,經腹腔引流治愈。結論 隨著手術者經驗的積累和技術的提高,腹腔鏡膽囊切除術治療萎縮性膽囊炎是切實可行的。
【關鍵詞】 腹腔鏡膽囊切除術;萎縮性膽囊炎
Laparoscopic cholecystectomy in treatment of 40 cases of atrophic cholecystitis
YI Zili,WEI Min 醫(yī).學全.在.線網站gydjdsj.org.cn
(Department of General Surgery,Wudong Hospital of Wuhan City,Wuhan 430086,China)
【Abstract】 Objective To explore the skills of laparoscopic cholecystectomy(LC)in the treatment of atrophic cholecystitis.Methods The clinical data of 40 patients with atrophic cholecystitis who underwent LC from 2006 to 2008 were retrospectively analyzed.Results LC succeeded in 37 cases of patients.3 cases were converted to open surgery,including two of them with the unclear anatomy of calot’s triangle,while one case with injured biliary tract.After the surgery,two patients got biliary leakage,but they were cured by intraperitoneal drainage.Conclusion With the experiences of surgery accumulation and improvements in technology,laparoscopic cholecystectomy is feasible to treat atrophic cholecystitis.
【Key words】 laparoscopic cholecystectomy;atrophic cholecystolithiasis
隨著醫(yī)學微創(chuàng)技術的不斷進步,腹腔鏡膽囊切除術(laparoscopic cholecystectomy,LC)已經日趨成熟,成為良性膽囊疾患的主要手術方式,它較傳統(tǒng)內科保守治療和外科開腹治療有著不可替代的優(yōu)勢,如手術時間短,創(chuàng)傷少,恢復快等[12]。然而萎縮性膽囊炎由于膽囊三角解剖關系模糊,是LC中轉開腹或發(fā)生出血、肝外膽道損傷等并發(fā)癥的最主要原因[3]。隨著腹腔鏡手術技術的進步和術者經驗的不斷積累,LC治療萎縮性膽囊炎已成為可能。本研究回顧性分析我院2006～2008年LC治療萎縮性膽囊炎40例,探討LC治療萎縮性膽囊炎的技巧,現總結如下。
1 萎縮性膽囊炎的診斷
①反復發(fā)作的上腹部鈍痛、悶脹痛等癥狀;②病史長達數年乃至10余年;③右上腹有輕壓痛或不適,Murphy征陰性;④B超檢查是診斷萎縮性膽囊炎的主要手段,典型表現為膽囊縮小,膽囊壁增厚,膽囊腔變窄或消失,同時伴有典型的增強光團和聲影,個別患者僅在相當于膽囊區(qū)的位置處探得伴有聲影的變形光帶;⑤為彌補B超對膽管疾患檢出率的不足,也可以適當的選擇靜脈膽道造影,經皮肝穿膽道造影及CT等檢查方法[4]。
2 LC治療萎縮性膽囊炎的技巧
