Chen X, Luo D, Li S, Mao J, Zhou Z, Yu S, Duan Z
Department of Hepatobiliary Surgery, Kunming General Hospital, Chengdu Military Command.
Chin Med J (Engl). 1996 Mar;109(3):223-7.
To study the causes and prevention of the complications of laparoscopic cholecystectomy (LC).
Based on experience with 2 428 cases, the following should be paid attention to when dissecting and separating adhesions around the gallbladder and of the Calot's triangle. The best method for the prevention of mistaking the common bile duct (CBD) for the cystic duct is to find the junction of the cystic infundibulum and duct, separate the gallbladder wall along the infundibulum, and transect the cystic duct at the junction with the infundibulum. If dense adhesions around the gallbladder or of the Calot's triangle are met with, LC should be abandoned and open the cholecystectomy (OC) should be used instead. In separating the Calot's triangle, blunt dissection should be used to avoid burning the extrahepatic bile duct (EHBD), and blind hemostasis should be avoided. If the cystic artery lies in the upper part and the back of the cystic duct, the cystic duct should be dissected out, clipped and cut first, then the cystic artery be dealt with. If the cystic artery is in the front part of the pedicle of the gallbladder, the artery should be separated, clipped and cut first. Injury to the adjacent organs may be avoided by using electric coagulating hook correctly and avoiding accidental damage to the viscera, and keeping from viscera injury due to current chemotaxis in the closed cavity of the body.
A total of 2427 patients were cured. One patient died of frequent episodes of supraventricular tachycardia and pneumonia on the 21st day after LC.
If LC surgeons follow the above said principles of LC technique. LC is very safe for patients with benign diseases of the gallbladder.
研究腹腔镜胆囊切除术（LC）并发症的原因及预防措施。
基于2428例手术经验，在解剖分离胆囊周围及胆囊三角粘连时应注意以下几点。预防将胆总管（CBD）误认作胆囊管的最佳方法是找到胆囊漏斗部与胆囊管的交界处，沿漏斗部分离胆囊壁，并在漏斗部与胆囊管交界处横断胆囊管。若遇到胆囊周围或胆囊三角致密粘连，应放弃LC，改行开腹胆囊切除术（OC）。在分离胆囊三角时，应采用钝性分离以避免灼伤肝外胆管（EHBD），并避免盲目止血。若胆囊动脉位于胆囊管的上部和后方，应先解剖出胆囊管，夹闭并切断，然后处理胆囊动脉。若胆囊动脉位于胆囊蒂的前部，应先分离、夹闭并切断动脉。正确使用电凝钩，避免意外损伤内脏，并防止因体内封闭腔隙内的电流趋化作用导致内脏损伤，可避免邻近器官损伤。
共2427例患者治愈。1例患者在LC术后第21天死于频发室上性心动过速和肺炎。
如果LC手术医生遵循上述LC技术原则，LC对胆囊良性疾病患者非常安全。
