34 例腹腔镜胆囊切除术后并发症分析

1993年 1月至 2 0 0 0年 12月 ,我院共施行腹腔镜胆囊切除术 (ｌａｐａｒｏｓｃｏｐｉｃｃｈｏｌｅｃｙｓｔｅｃｔｏｍｙ ,ＬＣ) 4 0 0 0例 ,发生各种并发症 34例 (占 0 85 % )。现报告如下。临床资料本组 34例 ,男 19例 ,女 15例。年龄 31～ 6 6岁 ,平均4 2岁。均因胆囊结石伴急性或慢性胆囊炎行ＬＣ。本组并发症等临床情况见表 1。表 1　34例ＬＣ的并发症及其处理并发症　　　　例数临床处理及结果胆总管部分裂伤 2 术中行修补加Ｔ管引流 3个月后拔管胆总管完全横断伤 1术中行吻合加Ｔ管引流 6个月后拔管胆囊管钛夹夹闭不全 1术后 15ｈ再…     

腹腔镜胆囊切除术后胆漏7例报告

胆漏是腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）后最常见和最严重的并发症之一,一旦发生并处理不当,将带来严重后果。本文对我院1993年12月～2006年10月3040例LC术后发生的7例胆漏进行回顾性分析,旨在探讨胆漏发生原因和有效的防治方法。     

腹腔镜胆囊切除术后恶心呕吐研究进展

术后恶心呕吐(postoperative nausea and vomiting,PONV)是腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)后最常见的并发症之一,发生率68%～72%[1].大多数病人在术后24 h内发生1～5次干呕或呕吐,少数病人可长达48 h[1].目前防治LC的PONV的措施较多.本文就此综述如下.     

腹腔镜胆囊切除术并发症的预防

腹腔镜胆囊切除术(LC)可达到传统开腹切除胆囊的效果且具有术后疼痛轻,住院时间短,创伤小,恢复快等优点,已成为切除胆囊手术的重要方法。随着LC病例的增多,已认识到行开腹胆囊切除术所发生的并发症均可发生于LC中,且后者对生命更具潜在的危险性。我院2001年~2005年11月共完成LC 384例,报告如下。1临床资料本组384例,其中男性116例,女性268例,年龄21~84岁,平均年龄48岁,有腹部手术史18例,全组病人术前均常规行B超检查。其中胆囊结石367例,胆囊息肉6例,急性胆囊炎11例。手术采用腹壁四孔或三孔技术入腹,CO2气腹压力维持在12~14mm Hg(1mm …     

腹腔镜胆囊切除术中出血三例分析

我院2002年12月至2006年5月,共施行腹腔镜胆囊切除术(LC)1630例,出现术中出血3例,发生率0.18%。术中出血是LC严重的并发症之一,文献报道其发生率约为1%。现将我院发生3例LC术中出血的原因及防治措施报道如下。     

腹腔镜胆囊切除术中特殊类型胆囊管的处理

目的介绍腹腔镜胆囊切除(LC)术中对某些特殊类型胆囊管的处理方法。方法本组12000例LC中约5％的胆囊管具有特殊解剖或病变解剖形状，对其腹腔镜下的处理技术及结果进行了回顾性分析。结果2例因直径过细而漏夹闭或直径过粗而夹闭不全的胆囊管术后出现胆汁漏，1例因胆囊管电热损伤，于术后第9天发生胆汁性腹膜炎。其余病人均获得一期恢复。结论LC术中宜根据这类特殊胆囊管的具体病变和解剖，针对性地采用不同的处理措施来避免常规方法可能带来的诸如胆囊管残端漏、肝外胆管损伤、胆囊管残留结石等并发症。     

腹腔镜胆囊切除术后迟发性胆瘘二例

腹腔镜胆囊切除术(Laparoscopic Cholecystectomy，LC)术后迟发性胆瘘较少见，我院自1991年3月至2003年12月14812例LC术后曾发生2例，现报告如下。     

腹腔镜胆囊切除术严重并发症10例报道

我院自1991．10～1994．11月，施行腹腔镜胆囊切除术(LC)2000余例，发生严重并发症10例，报道如下。     

腹腔镜胆囊切除术并发症的临床分析

对1068例电视腹腔境胆囊切除术(LC)的30例并发症进行分析。结果表明，并发症以截口感染为主(15例)；严重并发症包括肝下间隙脓肿(4例)，腹腔内出血(4例)，肝外胆道损伤(3例)，十二指肠穿孔(1例)等。作认为，培训稳定的腹腔镜手术班子，正确掌握LC手术指征，不断发展完善LC技术和设备将有利于减少并发症发生。     

腹腔镜胆囊切除术的胆道并发症

胆道并发症是腹腔镜胆囊切除术（ＬＣ）常见而严重的并发症。为减少此并发症,对３６０例ＬＣ进行了性分析。其中４例发生胆道工发症（１．１％）。包括３例胆管损伤（１例胆总管横断伤、１例胆总管穿孔、例肝总管部分夹１例胆囊管胆漏。胆总管横断伤的病人因诊断延迟死亡。对胆道并发症的发生原因、诊断和预防措施进行了分析并根据有关文献进行了讨论。     

SIADH following laparoscopic cholecystectomy

Purpose

To present an unusual case of inappropriate antidiuretic hormone secretion syndrome after a minor surgical procedure in a healthy patient.

Clinical features

A 71-yr-old woman underwent uneventful laparoscopic cholecystectomy for gallstones under general anaesthesia. Fifty-two hours post operatively she began convulsing and was found to have a serum sodium concentration as low as 112 mmol·L^?1. Serum osmolality, urinary sodium concentration and urine osmolality suggested a diagnosis of inappropriate antidiuretic hormone secretion. Subsequent treatment with anticonvulsants followed by strict fluid restriction which increased serum sodium concentrations led to rapid recovery.

Conclusion

The syndrome of inappropriate ADH secretion has several well documented causes including major surgery. Few episodes have been described following minor surgery in healthy patients and the only possible risk factor evident in this patient could be her advancing years.     

Jaundice following laparoscopic cholecystectomy

We report the first case of obstructive cholangitis after laparoscopic cholecystectomy, related to intraperitoneal retained gallstones. Received: 19 December 1996/Accepted: 16 May 1997     

Peritoneal gallstones following laparoscopic cholecystectomy

Background: Gallstone spillage during laparoscopic cholecystectomy (LC) is a common intraoperative event. Although gallstones left in the peritoneal cavity were initially considered harmless, a significant number of complications have been reported. Our aim was to quantify the likelihood, and to document the range, of subsequent complications.Methods: A Medline search from 1987 to January 2003 was performed. Articles with more than 500 LCs that quantified the frequency of complications due to peritoneal gallstones were reviewed, as were representative case studies of different stated complications.Results: Six studies, covering 18,280 LCs, were found. The incidence of gallbladder perforation was 18.3%, that of gallstone spillage was 7.3%, and that of unretrieved peritoneal gallstones was estimated to be 2.4%. There were 27 patients with complications. The likelihood of a complication when gallstone spillage occurred was 2.3%, which increased to 7.0% when unretrieved peritoneal gallstones were documented.Conclusion: Spilt gallstones have a small but quantifiably real risk of causing a wide range of significant postoperative problems.     

Bile leakage following laparoscopic cholecystectomy

Surgical Endoscopy -     

Pulmonary embolism following laparoscopic cholecystectomy

Laparoscopic abdominal surgery is considered a low-risk procedure for postoperative thromboembolic disease. We report two cases of pulmonary embolism following laparoscopic cholecystectomy, review the incidence of deep venous thrombosis and pulmonary embolism in laparoscopic cholecystectomy, and suggest a specific prophylactic scheme for patients undergoing laparoscopic cholecystectomy. In spite of the low incidence of postoperative thromboembolic disease following minimally invasive procedures, the risk of pulmonary embolism must not be underestimated and its symptoms must not be underdiagnosed.     

Bile leakage following laparoscopic cholecystectomy

Laparoscopic cholecystectomy (LC) is now the treatment of choice for gallstones, but there has been concern that bile leakage with LC is more frequent than after open cholecystectomy (OC). We have analyzed our experience of this complication with regard to both its incidence and management.From a consecutive series of 500 LC, in which both operative cholangiography and drainage of the gallbladder bed were routine, bile leakage was identified in ten patients (2%). There was no bile duct injury. Nine of the ten patients presented with bile in the drain within 24 h of operation and one patient presented 1 week after operation with a subphrenic collection. Of the ten patients, five settled spontaneously. Of the five remaining patients, two needed laparotomy—one for a subphrenic collection not responding to percutaneous drainage and one for biliary peritonitis. One patient was treated by relaparoscopy and suture of a duct of Luschka and one patient had successful percutaneous drainage of an infected collection; the fifth patient who presented with a late subphrenic collection of bile was shown at endoscopic retrograde cholangiopancreatography (ERCP) to have a cystic duct stump leak and was treated with an endoscopic stent.Bile leakage is seen more frequently after LC than OC for reasons that are currently unclear. We believe that the use of routine gallbladder bed drainage is justified for this reason alone. The majority of bile leaks settle either spontaneously or with minimally invasive intervention.     

Bilateral adrenal hemorrhage following laparoscopic cholecystectomy

Massive bilateral adrenal hemorrhage occurring in the postoperative period is an unusual but potentially life-threatening complication of any abdominal operation. The diagnosis is often difficult due to the nonspecific nature of the clinical presentation, which is easily attributable to other more common postoperative conditions. We report a case of bilateral adrenal hemorrhage resulting in acute primary adrenal insufficiency following an otherwise-uncomplicated laparoscopic cholecystectomy, which has not previously been described. An awareness of the possibility of this uncommon condition complicating laparoscopic cholecystectomy may lead to a higher index of suspicion, which is important in timely diagnosis and prompt treatment.     

腹腔镜胆囊切除术并发症分析

目的探讨腹腔镜胆囊切除术(LC)并发症发生的原因及处理措施。方法回顾性分析13例LC并发症的原因、处理方法和预防措施。结果发生并发症13例(1.01%),其中胆管损伤3例,胆漏3例,胆总管残余结石5例,腹壁戳孔结石残留2例。13例均及时处理后治愈。结论腹腔镜胆囊切除术并发症重在预防,完善术前检查,重视术中术后的每个环节是减少LC并发症的关健。     

Ruptured spleen following laparoscopic cholecystectomy.

BACKGROUND: Laparoscopic cholecystectomy is generally a safe and well-accepted procedure. However, in a small percentage of patients, it is associated with complications, such as bleeding and injury to the bile duct and other viscera. Splenic injury as a result of laparoscopic surgery has been reported only in the context of direct trauma, for example due to retraction in hand-assisted urologic surgery. To date, there have been no reported cases of patients requiring splenectomy following laparoscopic cholecystectomy. We report an unusual case of ruptured spleen presenting less than 28 days following "uncomplicated" laparoscopic cholecystectomy. RESULTS: A 52-year-old female presented to our Accident and Emergency department 3 weeks following "uncomplicated" laparoscopic cholecystectomy, complaining of severe left upper quadrant pain radiating to the left shoulder tip. Clinical examination revealed a patient in hypovolemic shock, with localized left upper quadrant peritonism. Abdominal computed tomography supported a diagnosis of splenic rupture, and the patient required an emergency splenectomy. DISCUSSION: Splenic injury rarely complicates laparoscopic cholecystectomy. We postulate that either congenital or posttraumatic adhesions of the parietal peritoneum to the spleen may have caused the capsule to tear away from the spleen when the pneumoperitoneum was established, resulting in subcapsular hematoma and subsequent rupture in this patient. Videoscopic assessment of the spleen at the end of laparoscopic cholecystectomy might be a worthwhile exercise to aid early recognition and management in such cases.     

Toxic shock syndrome following laparoscopic cholecystectomy

Toxic shock syndrome has been described in three clinical situations: pediatric abscesses; menses, especially among women using highly absorbent tampons; and after surgery. The syndrome is marked by the sudden onset of fever, a sunburn-like rash, and hypotension, and is associated with recovery of toxin-producing Staphylococcus aureus, usually from small amounts of serous or seropurulent fluid. The syndrome usually begins 1 to 2 days after the procedure. To date, no cases have been reported after laparoscopic surgery. We describe a case of postoperative toxic shock syndrome in a 41-year-old woman who underwent laparoscopic cholecystectomy. She required a second operation, antimicrobial therapy, and blood pressure support and eventually recovered fully. Culture of the operative bed yielded S. aureus that produced enteroxin B. Surgeons should investigate vigorously any fever and hypotension developing in the first 24 to 48 hours after laparoscopy. Toxic shock syndrome should be considered in the differential diagnosis.