关键词: 腹腔镜胆囊切除术, 困难胆囊切除

Abstract:

Management strategies of difficult laparoscopic cholecystectomy        WANG Jian. Department of Pancreaticobiliary Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
Abstract    The resection of gallbladder will be difficult when there exists some situations such as Mirrizi syndrome，gallbladder fistula，atrophic cholecystitis and gallbladder and cholecystitis with portal hypertension. Difficult laparoscopic cholecystectomy is the main cause of intraoperative bile duct and vascular injury. Surgical safety is the most important principle of difficult laparoscopic cholecystectomy. MRCP and enhanced CT should be conducted preoperatively so as to exclude biliary and blood vessels variation as well as to choose the appropriate time of surgery according to surgeon experiences and local inflammation. Surgeon should select the appropriate anatomical path and manners. Transection of cystic duct and cystic artery should be conducted after exposing Calot triangle clearly. Wound and drainage situations should be watched postoperatively. Several complications such as bile duct injury，vascular injury，bile leakage，cystic duct residual stones，gallbladder bed effusion and gastrointestinal injury and so on should be handled properly postoperatively.

Key words: laparoscopic cholecystectomy, difficult cholecystectomy