腹腔镜胆囊切除术并发症回顾及预防

目的探讨腹腔镜胆囊切除术（LaparoscopicCholecystectomy，LC）并发胆管损伤、胆漏和出血的原因、预防及处理。方法回顾性总结分析219例LC患者的临床资料。结果219例患者中216例在腹腔镜下完成手术，3例中转开腹（1．37％）。胆囊动脉后支撕脱出血5例（2．27％）；术后发生胆漏4例（1．82％）。结论肝外胆管、迷走胆管损伤及胆囊管残端钛夹脱落是LC术后胆漏的主要原因。正确解剖Calot三角，尽量靠近胆囊壁分离处理胆囊动脉、胆囊管，适当放宽中转开腹指征，可以预防胆漏和出血的发生。

Review and prevention of complications on laparoscopic cholecystectomy

Objective To summarize the prevention and treatment of complications, biliary injury and bleeding during laparoscopic cholecystectomy（LC）. Methods Retrospectively analyzed the clinical data of 219 patients underwent LC, and summarize the preventive measures of the complications, biliary injury and bleeding. Results 3 patients in 219 were converted to laparotomy（ 1.37% ） , and 4 cases were found bile leakage（ 1.82% ） , intraoperative hemorrhage due to cystic artery injury occurred in 5 cases（2.27% ）. Conclusion The injury of aberrant hepatic ducts and falling of titanium clamp of remnant of cystic duct were the common causes of bile leakage after LC. The maneuvers for prevention of bile leakage and hemorrhage during LC were accurate dissection of the Calot＇s triangle, careful ligation of cystic artery and cystic duct close to the gallbladder wall, and prompt performance of open cholecystectomy.