Laws H L
Department of Surgery, Carraway Methodist Medical Center, Birmingham, AL 35234, USA.
Semin Laparosc Surg. 1998 Jun;5(2):81-91. doi: 10.1177/155335069800500203.
All surgeons will encounter difficult cholecystectomies. Many trying and untenable situations can be prevented or made easier by the cautious surgeon who has a carefully thought-out plan for each potential problem. Step-by-step, this article addresses the arduous challenges that may be faced beginning with diagnosis and continuing through the operative procedure including the decision to operate, the best intervention, abdominal entry, dealing with common duct stones, intraoperative cholangiography, exposure of the biliary anatomy, avoidance of bleeding or common duct injury, spilled stones, and postoperative bile collection. Each problem is addressed with emphasis on prevention and management.
所有外科医生都会遇到困难的胆囊切除术。许多棘手且难以处理的情况可以被谨慎的外科医生预防或使其变得更容易,这些外科医生会针对每个潜在问题制定精心考虑的计划。本文将逐步阐述从诊断开始直至手术过程中可能面临的艰巨挑战,包括手术决策、最佳干预措施、腹部切开、处理胆总管结石、术中胆管造影、暴露胆道解剖结构、避免出血或胆总管损伤、结石散落以及术后胆汁积聚等问题。针对每个问题,本文都着重介绍了预防和处理方法。