腹腔镜胆囊切除术中胆囊动脉出血的预防及处理

目的探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中胆囊动脉出血的原因、预防及处理心得。方法 2000年2月～2012年8月实施LC 11 886例,其中146例(1.2%)术中发生胆囊动脉不同程度出血,通过钛夹夹闭、电灼、压迫止血。结果 144例成功完成LC,手术时间30～90 min,平均48 min;术中出血量200～500 ml,平均325 ml;无输血。中转开腹2例,1例胆囊动脉主干回缩至肝总管后方,无法施夹;1例合并肝硬化,胆囊床广泛渗血不止,系损伤肝中静脉的属支。146例术后随访3～6个月,平均4个月,未出现肝内外胆管损伤、继发出血、腹腔感染、肠梗阻等严重并发症。结论 LC术中胆囊动脉出血重在预防,一旦发生出血,应沉着、冷静,只要解剖结构熟悉,操作技术娴熟,选择合理的止血方法,胆囊动脉出血均能获得满意效果。

Management and Prevention of Cystic Artery Bleeding during Laparoscopic Cholecystectomy

Objective To investigate the causes, prevention and management of cystic artery bleeding during laparoscopic cholecystectomy （LC）. Methods We retrospectively analyzed the clinical data of 11 886 cases of LC that were carried out from February 2000 to August 2012. Among the patients, cystic artery bleeding occurred in 146 cases （1.2%）. Titanium clips, electronic coagulation and compression hemostasis were used to control the hemorrhage. Results LC was completed in 144 of the 146 patients within 30 to 90 min （mean, 48 min）, and the intraopcrative blood loss ranged from 200 to 500 ml （ mean, 325 ml）. No patient received blood transfusion. The other two patients were converted to open surgery due to the cystic artery shrinking back, behind the common hepatic duct, or uncontro]]able hemorrhage on the cystic bed caused by liver cirrhosis-related injury to the hepatic veins. The 146 patients were followed up for 3 to 6 months with a mean of 4 months, during which no injury to the extra- or intra-hepatic cystic duct, secondary hemorrhage, intra-abdominal infection, intestinal obstruction or other severe complications occured. Conclusions Prevention of cystic artery bleeding is the key for LC. When cystic artery bleeding occurs, as long as appropriate hemostasis is carried out by doctors familiar with anatomical structure and operational skills, the hemorrhage can be controlled.