Abstract: Objective To evalue the subserosal treatment of cystic artery for laparoscopic cholecystectomy in clinical application. Methods From January 2008 to October 2011,in 169 cases of LC, subserosal treatment of cystic artery branch which come into gallbladder wall was carried out after dissection of cystic duct and anterograde dissociation adjoin to the gallbladder wall. Treatment of the cystic artery included coagulation hook in 113 cases, ultrasonic Scalpel in 39 cases, Ligasure in 8 cases, titanium clip in 5 case and clip with Hem-O-Lok in 4 cases in which the cystic artery lined with the cystic duct was clipped together with the lined cystic duct. Results The procedure was completed in 169 of the cases under laparoscope. 8 cases underwent laparoscopic common bile duct exploration, T tube drainage of common bile duct at the same time. The operation time of the cases ranged from 25 to 205 min( mean, 43 min). The blood loss ranged from 5 to 250 mL ( mean, 10 mL ). It showed the cystic artery in the Calot`s tiangle that were originated from the right hepatic artery in 65cases and other artery in 104 cases that were treated with its branches, not search its source. Postoperative hospital stay was ranged from 1 to 12 days( m ean, 4.3 days ), 169 cases were followed up for 2 to 18 months ( mean, 8 months ). No abdominal hemorrhage or biliary injury occurred in all patients. Conclusions Subserosal treatment of cystic artery for laparoscopic cholecystectomy is more consistent with the concept of security and minimal invasion,and we recommend it as a promising technique for the operation.

Key words: cholecystectomy, laparoscopic, cystic artery

摘要： 目的 探讨浆膜下处理胆囊动脉的腹腔镜胆囊切除术在临床中的应用价值。 方法 回顾性分析2008年1月～2011年10月169例实施浆膜下处理胆囊动脉的腹腔镜胆囊切除术患者的临床资料，术中离断胆囊管后紧贴胆囊壁肌层平面顺行分离，于胆囊浆膜下处理胆囊动脉进入胆囊壁的分支，游离切除胆囊。胆囊动脉的处理：电钩梯度电凝113例，超声刀处理39例，Ligasure处理8例，钛夹5例，4例胆囊动脉与胆囊管伴行，处理上胆囊动脉与胆囊管一并用Hem-O-Lok夹闭。 结果 全组病例均在腹腔镜下完成手术，其中8例继而行胆总管切开取石，T管引流术，手术时间25～205min，平均43min；术中出血量5～250ml，平均10ml，术中解剖Calot三角内胆囊动脉发自肝右动脉65例，余104例仅解剖其分支，未追求其来源。术后住院时间1～12d，平均4.3d，术后随访2～18个月，平均随访8月，全组无腹腔出血、胆管损伤等并发症。 结论 浆膜下处理胆囊动脉的腹腔镜胆囊切除术更符合安全、微创的理念，是一种合理的手术方式，值得在临床推广。

关键词: 胆囊切除术，腹腔镜, 胆囊动脉