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醫(yī)學(xué)免費(fèi)論文:腹腔鏡膽囊切除術(shù)治療萎縮性膽囊炎40例體會(huì)
【摘要】 目的 探討腹腔鏡膽囊切除術(shù)(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(shù)治療萎縮性膽囊炎40例。結(jié)果 37例患者成功完成腹腔鏡膽囊切除術(shù),3例中轉(zhuǎn)開腹,其中2例是因?yàn)槟懩胰墙馄什磺?1例術(shù)中肝總管損傷。2例術(shù)后出現(xiàn)膽漏,經(jīng)腹腔引流治愈。結(jié)論 隨著手術(shù)者經(jīng)驗(yàn)的積累和技術(shù)的提高,腹腔鏡膽囊切除術(shù)治療萎縮性膽囊炎是切實(shí)可行的。
【關(guān)鍵詞】 腹腔鏡膽囊切除術(shù);萎縮性膽囊炎
Laparoscopic cholecystectomy in treatment of 40 cases of atrophic cholecystitis
YI Zili,WEI Min 醫(yī).學(xué)全.在.線網(wǎng)站m.bhskgw.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(xué)微創(chuàng)技術(shù)的不斷進(jìn)步,腹腔鏡膽囊切除術(shù)(laparoscopic cholecystectomy,LC)已經(jīng)日趨成熟,成為良性膽囊疾患的主要手術(shù)方式,它較傳統(tǒng)內(nèi)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(shù)時(shí)間短,創(chuàng)傷少,恢復(fù)快等[12]。然而萎縮性膽囊炎由于膽囊三角解剖關(guān)系模糊,是LC中轉(zhuǎn)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(shù)技術(shù)的進(jìn)步和術(shù)者經(jīng)驗(yàn)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(xiàn)總結(jié)如下。
1 萎縮性膽囊炎的診斷
①反復(fù)發(fā)作的上腹部鈍痛、悶脹痛等癥狀;②病史長達(dá)數(shù)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(xiàn)為膽囊縮小,膽囊壁增厚,膽囊腔變窄或消失,同時(shí)伴有典型的增強(qiáng)光團(tuán)和聲影,個(gè)別患者僅在相當(dāng)于膽囊區(qū)的位置處探得伴有聲影的變形光帶;⑤為彌補(bǔ)B超對膽管疾患檢出率的不足,也可以適當(dāng)?shù)倪x擇靜脈膽道造影,經(jīng)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
