30例有上腹部手术史的腹腔镜胆囊切除术治疗体会.doc

30例有上腹部手术史的腹腔镜胆囊切除术治疗体会
(作者:___________单位: ___________邮编: ___________)
【摘要】目的探讨上腹部手术史患者行腹腹腔镜胆囊切除术的可行性和手术特点。方法回顾分析我院30例有上腹部手术史的病例。结果 28 例成功,2 例中转开腹,手术时间30~140 分钟,%。结论有上腹部手术史患者若方法得当可以完成手术。气腹的建立、穿刺孔的选择,粘连的分离应予注意。
【关键词】腹腔镜胆囊切除术;粘连;上腹部手术史
[Abstract] Objective to explore the feasibility and characteristics of laparoscopic cholecystectomy in patients with a history of epigastric operation. Methods Retrospectively analyze 30 cases with a history of epigastric operation cases. Results 28 cases were essful, 2 cases were converted to laparotomy, operation time was between 30 to 120 minutes , all patients were cured, the ess rate of LC was %. Conclusion If the method is proper, the patients with a history of epigastric operation plete the LC .Establishment of pneumoperitoneum, the choice of puncture holes ,adhesion separation should be noted.
[Keywords] laparoscopic cholecystectomy; adhesion; the history of epigastric operation
腹腔镜胆囊切除手术(laparoscopic cholecy- stectmoy, lc)因损伤小,痛苦小,恢复快,住院时间短,费用不高等优点,已成为治疗胆囊良性疾病的金标准。随着腹腔镜手术经验的不断丰富,器械的不断发展。Lc术的手术适应征正在扩大。我院2003 年11 月~2011 年9 月对上腹部手术史患者腹腔镜切除术30 例,取得满意结果,现报告如下:
1 资料与方法
一般资料
本组30 例,男18 例,女12 例,年龄43~69 岁,有高脂饮食后上腹部疼痛发作病史半月至15 年,术前B超,CT或MRCP检查诊断为胆囊结石胆囊炎。其中有胃大部切除术史 5例,胃十二指肠溃疡穿孔修补术8例,胃癌根治术11 例,脾切除术6 例,本次手术距上次手术时间为1~20 年, 年。均为一次手术。切类型,径右腹直肌切口8 例,正中切口16 例,左腹直肌切口 3 例,左肋缘下切3 例。
方法
手术均在全麻下进行,根据手术切加类型,选择