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- Laparoscopic Cholecystectomy for Post-Gastrectomic Patients
- 腹腔鏡膽囊切除術
- 腹腔鏡膽囊切除術之膽道相關併發症
- The Role of Laparoscopic Cholecystectomy in Treating Gangrenous Cholecystitis
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題 名 | Laparoscopic Cholecystectomy for Post-Gastrectomic Patients=胃切除術後病人之腹腔鏡膽囊切除術 |
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作 者 | 游憲章; 袁瑞晃; | 書刊名 | 中華民國外科醫學會雜誌 |
卷 期 | 28:6 民84.11-12 |
頁 次 | 頁462-467 |
分類號 | 416.247 |
關鍵詞 | 胃切除術; 腹腔鏡; 膽囊切除術; Post-gastrectomy; Iaparoscopic cholecystectomy; Mini-laparotomy; |
語 文 | 英文(English) |
中文摘要 | 自從1990年十月引進後,由於傷口小、美觀、恢復快、住院時間短,因此腹腔鏡膽囊切除術已逐漸為人接受為膽囊結石病人的基本術式,至於上腹腔曾經接受過胃切除手術者,在進行腹控鏡膳囊切除術時往往會遇到困難,因此提出加以討論。臺大醫院由1990年十月到1995年六月,共進行八百二十五例腹腔鏡膽囊切除術,其中有十二例是接受過胃切除手術者(十一例次全胃切除,一例全胃切除),而其疾病種類包括六例十二指腸潰膚、兩例穿孔性潰瘍、兩例胃潰瘍以及兩例胃癌。男性八例而女性四例,其年齡分布介於32~84之間,平均年齡60.6歲。為了避免腹腔內器官因以前胃切除手術後所造成的沾黏,導致氣腹針插入時造成傷害,因此採用肚臍右緣迷你切開術,以避開傷口下的沾黏,並在直視下放入套管,之後先插入兩個5mm管套以分離上腹部的沾黏後,再插入上腹部操作套管。此外膽囊先由底部沿著邊緣往膽囊管方向分離,並先將膽囊接近哈氏憩室部位和肝臟分離,以利膽囊及膽囊管交界處的鑑別,避免總膽管的傷害。十二例病人的結果為:手術時間最長247分鐘,最短51分鐘,平均111.17分鐘;手術後進食時間介於6~48小時,平均17.5小時;手術後住院日數最短一天,最長一周,平均3.3天。手術時間的長短和以前的疾病種類並無關係,除了手術時間較一般腹腔鏡膽囊切除術長外,病人開始進食時間以及住院日數均比傳統手術短,恢復快且傷口小而且美觀。因此認為對於上腹部曾經接受為切除手術的病人而言,對於接受過完整訓練的醫師言,只要小心謹慎、按步就班,除了對手術者是體力以及耐力的考驗外,腹腔鏡膽囊切除術是一種安全且有意義的手術。 |
英文摘要 | Laparoscopic cholecystectomy has become the preferred choice of surgical procedure for uncomplicated cholecystolithiasis. With the advances in techniques and instruments, procedures for difficult laparoscopic cholecystectomy have been improved. Between December 1990 and June 1995, 825 cases of laparoscopic cholecystectomy were performed at National Taiwan University Hospital; 548 of those received surgery by the same operative team. Among those patients, 12 had received subtotal or total gastrectomy several years previously. According to experience here the key points of operation for post-gastrectomic patients are: (1)A mini-laparotomy beginning from the right inferior margin of the umbilicus made to facilitate entry of the first trocha and avoid hollow organ injury from adhesion after the previous operation. (2) Insertion of a mid-clavicular port and anterior axillary port for dissection of adhesions beneath the previous operation wound; then the upper midline port can safely be placed under laparoscopic vision. (3) Initial dissection made along both the gallbladder margins until arriving at the junction with the cystic duct. (4) If the cystic duct was not exposed properly, the base of the gallbladder adjacent to the Hartmann's pouch was taken off the liver bed to facilitate identifying the cystic duct. (5) During operation, manipulation should keep away from the round ligament area to avoid injury to the common blie duct. (6) The gallbladder can be removed from the abdominal cavity through mini-laparotomic region. (7) Closure of the fascia of the mini-laparotomic region avoids ventral herniation, postoperatively. The operation time in these cases ranged from 51 to 247 minutes, with a mean of 111 minutes. The postoperative hospital stay ranged from one to seven days, with a mean of 3.3 days. Postoperative feeding time ranged from 6 hours to 48 hours, with average of 17.5 hours. In conclusion, it appears that, although adhesiolysis and identification of the anatomic structure are time-consuming, laparoscopic cholecystectomy is feasible and safe for a well-trained surgeon. For the patient's sake, these procedures are well worth the effort. |
本系統中英文摘要資訊取自各篇刊載內容。