目的探讨腹腔镜胆囊切除术（LC）中后三角及胆囊管零距离解剖的临床价值。方法以我院收治的100例慢性胆囊炎胆囊三角粘连患者为研究对象,其中50例采用后三角及胆囊管零距离解剖行LC（后三角组）;另50例采用前三角手术入路行LC（前三角组）。对比两组术中胆漏率、出血率、转开放手术率及总有效率。结果后三角组胆漏率、出血率及转开放手术率均低于前三角组（P〈0.05或P〈0.01）;后三角组总有效率高于前三角组（P〈0.05）。结论 LC中后三角及胆囊管零距离解剖能够减少手术胆漏率、出血率及转开放手术率,提高总有效率。该方法具有创伤小、恢复快、安全性高等优点,值得临床推广应用。

Objective To investigate the clinical value of laparoscopic cholecystectomy ( LC) in the rear triangle and the cystic duct the zero anatomy .Methods The clinical data of 100 cholecystectomy patients who were the patients with cystohepatic triangle lentor were analyzed retrospectively .Fifty patients received the rear triangle and the cystic duct the zero anatomy ( rear triangle group ) , while the other 50 patients received the surgery from the front triangle to road ( front triangle group ) .The operative bile leakage rate , bleeding rate ,turn open operability and overall curative effects of the patients in both groups were compared .Results The bile leakage rate,bleeding rate and turn open operability of the patients in the rear triangle group were lower than those of the patients in the front triangle group( P <0.05 or P <0.01), and the total effective rate of the rear triangle group was higher than that of the front triangle group (P <0.05).Conclusion Laparoscopic cholecystectomy

目的：探讨腹腔镜下胆囊切除术(LC)在胆囊三角粘连时的安全性及有效性。方法回顾性分析39例胆囊三角粘连行LC患者的临床资料,观察手术效果。结果顺利完成LC 37例,手术时间30~175 min,平均手术时间(65±8)min,中转开腹2例。39例平均术后住院时间(3.0±0.5)d。36例获得随访9~25个月,无近期并发症。结论LC对胆囊三角粘连的病例是一种安全、可行的手术方法。

Objective To investigate the safety and effectiveness of laparoscopic cholecystectomy (LC) for calot triangle chronic adhesion.Methods The clinical data of 39 calot triangle chronic adhesion patients undergoing LC were retrospectively analyzed, and the operation effect was observed.Results There were 37 cases underwent successful LC, and the operation time was 30~175 min, with an average time of (65±8)min. There were 2 cases underwent laparotomy instead. The average hospital stays of the 39 cases was (3.0±0.5)d. Follow-up lasted for 9~25 months in 36 cases, and there was no short-term complications.Conclusion LC is a safe and feasible surgery method for treating calot triangle chronic adhesion.

目的：探讨胆囊后－前三角联合解剖法在腹腔镜胆囊切除术中的应用价值。方法回顾性分析2011年4月－2013年12月苏州大学附属第三医院收治的250例腹腔镜胆囊切除术患者的临床资料，包括手术时间、出血量和手术并发症。结果246例手术成功，手术时间25-120min，平均42min。术中出血量5-80ml，平均20ml。其中2例各因合并胃癌和胆囊结肠瘘中转开腹手术，2例行腹腔镜下胆总管切开取石术。全组术后均无腹腔出血、胆漏及胆道狭窄等严重并发症。结论胆囊后－前三角解剖法有助于辨认Calot三角内的解剖结构，可有效减少术中出血和胆管损伤，安全可行。

Objective To investigate the value and clinical application of posterior-anterior cystohepatic triangle dissection in laparoscopic cholecystectomy (LC).Methods The medical records of 250 patients who underwent LC were reviewed.The clinical data,including oper-ating time,amount of bleeding,and surgical complications,were retrospectively analyzed.Results LC was successfully completed in 246 cases.The operating time ranged from 25 min to 120 min,with a mean of 42 min.The amount of bleeding ranged from 5 ml to 80 ml,with a mean of 20 ml.Two cases were converted to open surgery due to gastric carcinoma or cholecystocolonic fistula,and 2 cases underwent lap-aroscopic common bile duct exploration.There was no report of severe complications in the entire group,such as abdominal hemorrhage,bile leakage,and biliary stricture.Conclusion With proper identification of the anatomical structure,it is safe and feasible to perform LC by dissection of the posterior-anterior cystohepatic triang

目的：探讨腹腔镜胆囊切除术后并发症发生的危险因素。方法：回顾性分析我院2009年01月～2013年12月住院并行腹腔镜胆囊切除术512例患者的临床资料，应用和logistic方法分析腹腔镜胆囊切除术后并发症的发生率和相关因素。结果：512例患者并发症的发生率为2.53%，主要为胆道损伤、腹腔内出血、内脏损伤、肝床积液；单因素分析结果显示：Calot三角粘连、胆囊与周围粘连、解剖变异、合并病变和医生的手术经验与术后并发症有关（P<0.05）；多因素分析结果显示：Calot三角粘连（OR=2.721，95%CI=1.371～5.399）、胆囊与周围粘连（OR=4.059，95%CI=1.145～14.396）、医生的手术经验（OR=4.637，95%C I=1.543～13.930）是腹腔镜胆囊切除术后并发症的主要危险因素（P<0.05）。结论：胆道损伤、腹腔内出血、内脏损伤、肝床积液是腹腔镜胆囊切除术后的主要并发症，Calot三角粘连、胆囊与周围粘连、医生的手术经验是其主要的危险因素。

Objective:To investigate the risk factors for to complications after laparoscopic cholecystectomy. Methods: A retrospective analysis of data from October 2009 to March 2013 gal bladder disease in patients with laparoscopic cholecystectomy converted to laparotomy operation cases.Results: The rate of postoperative complication was 2.53 . Bile duct injury, abdominal cavity hemorrhage, visceral injury and liver fluid bed was major complications Logistic regression analysis revealed that Calot triangle adhesion(OR=2.721,95%CI=1.371~5.399), operative skil (OR=4.059,95%CI=1.145~14.396), adhesion between gal bladder and abdominal cavity(OR=4.637,95%CI=1.543~13.930) were significant factors for patients with laparoscopic cholecystectomy. Conclusions: Bile duct injury, abdominal cavity hemorrhage, visceral injury and liver fluid bed was major complications. Calot triangle adhesion, operative skil , adhesion between gal bladder and abdominal cavity were significant factors for patients with lapar

目的探讨腹腔镜胆囊切除术在老年患者的临床应用疗效并对并发症危险因素进行研究。方法根据治疗方法的不同将230例胆囊切除术老年患者分为开腹手术组（62例）及腹腔镜手术组（168例）,比较两组手术效果及术后胃肠功能恢复情况。同时采用Logistic回归分析腹腔镜胆囊切除术并发症危险因素。结果腹腔镜手术组手术时间、术中出血量、引流量、下床活动时间及住院天数显著少于开腹手术组（P〈0.05）;术后肛管排气时间及肠鸣音恢复时间显著早于开腹手术组（P〈0.05）;腹腔镜手术组共有13例（7.7%）患者发生术后并发症。胆囊壁厚、白细胞计数、Calot三角粘连、胆囊颈部结石嵌顿是腹腔镜术后并发症的风险因素,Calot三角粘连是术后并发症的独立风险因素。结论老年患者行腹腔镜胆囊切除术治疗对机体损伤小、术后恢复快,Calot三角粘连是术后并发症的独立风险因素。

Objective To understand the effects of laparoscopic cholecystectomy and the factors that cause postoperative complications in the process of treating elderly patients . Method 230 elderly cases undergoing laparoscopic cholecystectomy were selected as research subjects .The patients were divided into open abdominal operation group ( 62 cases) and laparoscopic operation group (168 cases) based on operative Method .The operation effect and recovery of gastrointestinal function were compared between the two groups .Risk factors of the operation-related complications were studied by Logistic regression analysis .Findings Laparoscopic surgery operative time , blood loss, drainage flow, leaving bed time and hospital stay were significantly less than the open surgery group ( P <0.05);postoperative anal exhaust time and time needed for intestinal voice restoration were significantly earlier than the open surgery group ( P <0.05 );Postoperative complications was 7.7%( 13 cases) in the laparoscop