腹腔镜胆囊切除术后并发症的原因及防治(附376例报告)

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)常见并发症的原因及预防措施。方法:回顾分析2005年11月至2011年11月为376例患者行LC的临床资料,分析其并发症发生原因,总结防治措施。结果:8例(2.1%)中转开腹;16例(4.26%)发生并发症,其中胆漏4例,1例胆囊床胆汁渗漏,3例胆囊管残端漏;2例胆管损伤;出血5例,4例胆囊动脉出血,1例胆囊床渗血;胆总管残余结石(术中胆囊内结石滑入胆总管下端)2例;皮下气肿1例;内脏戳伤1例;腹腔感染、腹腔积液1例,无一例死亡。结论:LC治疗胆囊良性疾病是安全有效的,严格掌握手术指征,操作技巧熟练,操作规范,熟悉胆囊管及胆囊动脉解剖及变异,术中及时果断中转开腹等,是有效预防LC并发症的关键。

Cause, prevention and treatment of postoperative complications of laparoscopic cholecystectomy: with a report of 376 cases

Objective:To explore the causes and preventive measures of the complications of laparoscopic cholecystectomy(LC).Methods:The clinical data of 376 cases of LC between Nov.2005 and Nov.2011 were analyzed retrospectively.The causes of complications were analyzed,the prevention and treatment were summarized.Results:Eight patients(2.1%) were converted from LC to open cholecystectomy.16 cases(4.26%) suffered from various complications.The complications included 4 cases of bile leakage:one from cystic bed,3 from residual cystic duct;2 cases of bile duct injury;5 cases of bleeding:4 from cystic artery,one from cystic bed;2 cases of remnant common bile duct calculi(cholecystolithiasis slided into common bile duct during operation);1 subcutaneous emphysema;1 abdominal viscera injury;1 abdominal infection and hydrops;no death occurred.Conclusions:LC is safe and effective in treating benign cholecyst diseases.It must be performed with strict indications,reasonable operation skill,standard manipulation,familiar anatomic variation of cholecystic vessel and biliary duct and timely conversion to open cholecystectomy,all methods can effectively prevent the complications of LC.