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医学免费论文:腹腔镜胆囊切除术治疗萎缩性胆囊炎40例体会
【摘要】 目的 探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗萎缩性胆囊炎的技巧。方法 回顾分析我院2006～2008年腹腔镜胆囊切除术治疗萎缩性胆囊炎40例。结果 37例患者成功完成腹腔镜胆囊切除术,3例中转开腹,其中2例是因为胆囊三角解剖不清,1例术中肝总管损伤。2例术后出现胆漏,经腹腔引流治愈。结论 随着手术者经验的积累和技术的提高,腹腔镜胆囊切除术治疗萎缩性胆囊炎是切实可行的。
【关键词】 腹腔镜胆囊切除术;萎缩性胆囊炎
Laparoscopic cholecystectomy in treatment of 40 cases of atrophic cholecystitis
YI Zili,WEI Min 医.学全.在.线网站www.lindalemus.com
(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
随着医学微创技术的不断进步,腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)已经日趋成熟,成为良性胆囊疾患的主要手术方式,它较传统内科保守治疗和外科开腹治疗有着不可替代的优势,如手术时间短,创伤少,恢复快等[12]。然而萎缩性胆囊炎由于胆囊三角解剖关系模糊,是LC中转开腹或发生出血、肝外胆道损伤等并发症的最主要原因[3]。随着腹腔镜手术技术的进步和术者经验的不断积累,LC治疗萎缩性胆囊炎已成为可能。本研究回顾性分析我院2006～2008年LC治疗萎缩性胆囊炎40例,探讨LC治疗萎缩性胆囊炎的技巧,现总结如下。
1 萎缩性胆囊炎的诊断
①反复发作的上腹部钝痛、闷胀痛等症状;②病史长达数年乃至10余年;③右上腹有轻压痛或不适,Murphy征阴性;④B超检查是诊断萎缩性胆囊炎的主要手段,典型表现为胆囊缩小,胆囊壁增厚,胆囊腔变窄或消失,同时伴有典型的增强光团和声影,个别患者仅在相当于胆囊区的位置处探得伴有声影的变形光带;⑤为弥补B超对胆管疾患检出率的不足,也可以适当的选择静脉胆道造影,经皮肝穿胆道造影及CT等检查方法[4]。
2 LC治疗萎缩性胆囊炎的技巧
