腹腔镜胆囊切除手术入路研究现状及进展

Research Status and Advances in Surgical Approaches for Laparoscopic Cholecystectomy

摘要: 胆囊良性疾病是临床常见的消化系统疾病，其发病率伴随生活方式的改变呈上升趋势。腹腔镜胆囊切除术(Laparoscopic Cholecystectomy, LC)凭借其微创优势，已成为该病的首选治疗方式。然而，胆道损伤作为LC最严重的并发症，仍严重威胁患者预后，其发生主要与胆囊三角区解剖结构辨识困难有关。手术入路作为LC操作的核心环节，直接关系解剖视野的清晰度、关键结构的辨识准确性及整体手术安全性，合理选择入路对降低并发症风险具有关键意义。本文系统梳理近年国内外相关研究，围绕“关键安全视野(CVS)”与“退出策略(Bailout Procedure)”两大核心安全理念，总结LC常用手术入路的技术特点与临床应用，包括经典的胆囊前三角入路、胆囊后三角入路，创新的“V”形、“Y”形及“T”形解剖入路，以及适用于复杂病例的胆囊底入路、壶腹入路与胆囊内入路等。进一步探讨不同入路在实现CVS或作为Bailout策略中的角色与选择逻辑，对规范手术操作、优化治疗策略及改善患者预后具有重要临床价值。

Abstract: Benign gallbladder diseases are common clinical disorders of the digestive system, with an increasing incidence linked to changes in lifestyle. Laparoscopic cholecystectomy (LC) has become the preferred treatment due to its minimally invasive advantages. However, bile duct injury, the most severe complication of LC, remains a significant threat to patient outcomes, primarily associated with difficulties in identifying anatomical structures within the Calot’s triangle. The surgical approach, as a core element of LC, directly affects the clarity of the anatomical field, the accurate identification of critical structures, and overall procedural safety. Therefore, the appropriate selection of an approach is crucial for reducing complication risks. This review systematically summarizes recent domestic and international studies, focusing on the core safety concepts of the Critical View of Safety (CVS) and Bailout Procedures. It outlines the technical characteristics and clinical applications of common LC surgical approaches, including the classic anterior and posterior cystic triangle approaches, innovative anatomical approaches such as the “V”, “Y”, and “T” shaped dissections, as well as specialized approaches for complex cases like the fundus-first, infundibular, and intracorporeal approaches. Furthermore, it explores the role and selection rationale of different approaches in achieving CVS or serving as a Bailout strategy, highlighting significant clinical value for standardizing operative procedures, optimizing treatment plans, and improving patient outcomes.