腹腔镜手术, 胆囊结石, 胆总管结石, 腹腔粘连, 结石嵌顿

Objective To explore the effects of different handling ways for complex cholecystolithiasis and choledocholithiasis in laparoscopic operation. Methods A retrospective analysis of 136 patients with complex cholecystolithiasis and choledocholithiasis in Qingdao Municipal Hospital was carried out, and the effects of different sudden intraoperative conditions and the corresponding treatment techniques and methods were summarized. Results In this study, the abdominal adhesion patients accounted for 88.2% (120 cases), including 73 cases of inflammatory adhesion and 47 cases of postoperative adhesion. During the operation, the principle of “calming the liver and gallbladder, keeping away from the porta hepatis” and the corresponding treatment skills were followed. 98 cases (81.7%) with abdominal adhesion were successfully completed according the original operation plan, while 22 cases (18.3%) were converted to open surgery due to the unclear identification of common bile duct or cystic neck tube during the operation. 16 cases (11.8%) in the total group had stone incarceration, including stone incarceration in neck of gallbladder and common bile duct. The techniques of pushing method, direct lithotomy and electrohydraulic lithotripsy were applied during operation, combined with choledochoscopy, lithotripter and balloon dilator. Conclusion Abdominal adhesion and calculus incarceration are the most common difficulties in laparoscopic surgery for complex cholecystolithiasis and choledocholithiasis. The corresponding intraoperative decision-making and management skills can provide more methods and ideas for improving the safety of patients, reducing the risk of surgery and reducing postoperative complications.

laparoscopy, cholecystolithiasis, choledocholithiasis, abdominal adhesions, stone stagnation