临床研究(Clinical Research)

腹腔镜下胆囊动脉入路精细解剖胆囊三角的临床价值

Published at: 2015年第24卷第8期

周红兵 1 , 杨兴业 1 , 陈曦 1 , 周存才 2
1 江苏省泰州市人民医院 肝胆外科,江苏 泰州 225300
2 江西省肿瘤医院 肝胆外科,江西 南昌 330000
通讯作者 红兵 周 Email: 327543501@qq.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2015.08.013
基金:

摘要

目的:探讨应用腹腔镜下胆囊动脉入路精细解剖胆囊三角技术预防腹腔镜胆囊切除(LC)术中胆道损伤的临床价值。方法:回顾性分析2010 年6 月—2014 年6 月期间2 200 例采用此技术行LC 患者的临床资料,该技术要点即优先处理胆囊动脉,精细解剖、掏空胆囊三角,完全充分的显露三管关系。结果:2 152 例患者顺利完成LC,均未发生胆道损伤,其余48 例(2.18%)因Mirizzi 综合征、胆囊十二指肠内瘘、胆囊癌中转开腹手术。手术时间20~55 min,平均35.5 min;术中出血量5~50 mL,平均15.5 mL;术后住院时间3~5 d,平均3.5 d。术后随访3~12 个月,无肝内外胆管狭窄、胆瘘、腹腔脓肿等并发症发生。结论:采用“腹腔镜下胆囊动脉入路精细解剖胆囊三角”技术能有效预防LC 术中胆道损伤,可作为手术规范积极推广。


Clinical value of laparoscopic meticulous dissection of Calot’s triangle via cystic artery approach

Abstract

Objective: To evaluate the clinic value of using the technique of “laparoscopic meticulous dissection of Calot’s triangle via cystic artery approach” for preventing bile duct injury during laparoscopic cholecystectomy (LC). Methods: The clinical data of 2 200 patients undergoing LC with this technique from June 2010 to June 2014 were analyzed retrospectively. The essential feature of the technique was namely “cystic artery first”, and full exposure of the relationship of the three biliary ducts after meticulously dissecting out the contents of Calot’s triangle. Results: LC procedure was successfully completed in 2 152 patients, without bile duct injury occurring in any of them, and the other 48 patients (2.18%) were converted to open surgery due to Mirizzi’s syndrome, cholecystoduodenal fistula or gallbladder cancer The operative time was 20 to 55 min, with an average of 35.5 minutes, the intraoperative blood loss was 5 to 50 mL, with an average of 15.5 mL, and the length of postoperative hospital stay was 3 to 5 d, with an average of 3.5 d, respectively. Follow-up performed for 3 to 12 months, and no complications such as biliary stricture, bile leakage or intraperitoneal abscess occurred. Conclusion: Using the technique of “laparoscopic meticulous dissection of Calot’s triangle via cystic artery approach” can effectively prevent bile duct injury during LC, and it can be recommended as a standard procedure.


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引用

引用本文: 红兵 周, 兴业 杨, 曦 陈, 存才 周. 腹腔镜下胆囊动脉入路精细解剖胆囊三角的临床价值[J]. 中国普通外科杂志, 2015, 24(8): 1121-1124.
Cite this article as: ZHOU Hongbing, YANG Xingye, CHEN Xi, ZHOU Cuncai . Clinical value of laparoscopic meticulous dissection of Calot’s triangle via cystic artery approach[J]. Chin J Gen Surg, 2015, 24(8): 1121-1124.