腹腔镜胆囊切除术结石漏入腹腔的预防

目的:探讨腹腔镜胆囊切除术（LC）中结石漏入腹腔的原因、预防措施及处理方法。方法:回顾分析1510例LC术中73例结石漏入腹腔发生的原因及处理方法。结果:结石自胆囊管破口漏出6例,牵拉和剥离致胆囊破裂结石漏出41例,自腹壁戳孔取出胆囊时拉破19例,血管钳扩大戳孔刺破胆囊7例。漏入腹腔的结石均被取出,2例中转为开腹取石。此组结石漏入腹腔的发生率为4.8％（73/1510）。结论:LC术中剥离和取出胆囊过程是结石漏入腹腔的主要发生时期,防止胆囊分破和取出时拉破是预防结石漏入腹腔的关键。     

LC术中结石漏入腹腔的处置(附182例报告)

目的 :探讨腹腔镜胆囊切除术中结石漏入腹腔的处置方式。方法 :回顾分析 10 86 5例LC术中发生结石漏入腹腔 346例 (3.18% )的原因及处置方式。结果 :346例结石漏入腹腔用传统取石方法取石 16 4例 ,用吹筒取石法取石 182例 ,后者取石时间明显缩短 ,腹腔残石发生率明显降低。结论 :预防漏入腹腔结石的关键是LC术中要防止分破或取出时撕破胆囊 ,以致胆汁、结石漏入腹腔。胆囊分破、结石落入腹腔后随着LC术中结石漏入腹腔处理方式的改进 ,取石时间缩短 ,腹腔残石发生率会明显降低。     

腹腔镜胆囊切除术中结石漏入腹腔的原因及对策

目的：探讨腹腔镜胆囊切除术（LC）结石漏入腹腔发生的原因,预防措施及处理方法。方法：回顾分析了1991年9月－1999年12月7200例LC术中结石漏入腹腔患者发生的原因,探讨其临床预防措施及处理成功的经验。结果：LC术中结石入腹腔363例,其中LC术中胆囊分破所致219例,钳夹胆囊侧胆囊管钛铗脱落所致43例,自腹壁戳孔取出时撕破34例,分离钳扩开戳孔时刺破67例,结石漏入腹腔发生率约为5％,LC术中结石入腹腔后多全部取出,。腹腔残留结石患者确切数目不甚清楚,随访1－8年无腹腔脓肿,窦道形成等并发症出现,结论：LC术中胆囊分破,钳夹胆囊侧胆囊管的钛铗碰落,自腹壁翟孔取出时用力撕破或胆囊取出时因戳孔过小扩开时刺破是LC术中结石漏入腹腔的主要原因,LC术中一旦结石脱入腹腔采取必要的方法全部取出是减少或避免腹腔残石发生的主要措施。LC术中结石脱入腹腔未能全部取出,可严密观察随访,不必为此中转开腹。     

腹腔镜胆囊切除术中结石漏入腹腔的处置体会

目的：探讨腹腔镜胆囊切除术中结石漏入腹腔的处置方式。方法：探讨腹腔镜胆囊切除术中结石漏入腹腔的处置方式。结论：预防腹腔漏入结石的关键是LC术中防止胆囊分破或取出时撕破致胆汁、结石漏入腹腔，胆囊分破、结石落入腹腔后采取必要的处理措施，随着LC术中腹腔漏入结石处理方式的改进，取石时间缩短，腹腔残石发生率大大降低。     

腹腔镜胆囊切除术结石漏入腹腔的原因及对策

目的：探讨腹腔镜胆囊切除术结石漏入腹腔的原因及防治对策。方法：回顾性分析我院1998年至2007年1200例腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）结石漏入腹腔的临床资料。结果：1200例LC共发生结石漏入腹腔61例,随访1-8年,无腹腔脓肿、窦道形成等并发症发生。结论：LC术中胆囊分破、取出时撕破、血管钳扩开戳孔时刺破胆囊是结石漏入腹腔的主要原因,术中避免以上情况的发生并将漏入腹腔结石取净是避免术后并发症发生的关键。     

腹腔镜胆囊切除术结石漏入腹腔的原因及对策

近年来有关腹腔镜胆囊切除术 (ＬＣ)后腹腔残留结石引起腹腔脓肿、窦道形成个案报道甚多。本文拟对ＬＣ术后腹腔残留结石发生的原因、预防措施及处理方法进行探讨。1　临床资料我院 1992年 9月至 2 0 0 1年 9月共完成 72 0 0例ＬＣ术 ,其中慢性胆囊炎 6 4 13例 ,急性胆囊炎 713例 ,萎缩性胆囊炎 74例。本组病例共发生结石落入腹腔 36 3例 ,其发生率约为 5 % ,其中包括急性胆囊炎 16 8例 ,慢性萎缩性胆囊炎 6 4例 ,慢性胆囊炎 131例。其发生的原因为 :ＬＣ术中胆囊分破所致 2 18例 ,钳夹胆囊侧胆囊管的钛铗碰落 4 3例 ,自戳孔取出胆囊时撕破 …     

腹腔镜胆囊切除术结石漏入腹腔的原因及处理

近年来，有关腹腔镜胆囊切除术（LC）后腹腔残留结石引起腹腔脓肿、窦道的报道较多，现回顾分析我院56例LC术中结石漏入腹腔的原因及处理方法如下。     

腹腔镜胆囊切除术胆漏的原因分析及对策

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)后胆漏的原因及处理措施。方法:选择2004年10月至2014年10月1 500例LC患者作为观察对象,回顾分析其中13例术后发生胆漏患者的临床参数、处理方式及手术相关并发症。结果:1 500例LC患者中共13例发生胆漏,胆漏发生率0.87%,均予以充分的腹腔引流。胆漏原因考虑与术前胆囊炎症程度、局部粘连、结石嵌顿与否等情况有关。8例患者经5~14 d对症治疗痊愈;5例采取内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)联合腹腔引流,其中3例予以鼻胆管引流4周后痊愈,另2例行十二指肠乳头括约肌切开术双根塑料支架引流,3个月后取出支架痊愈。半年后胆漏患者经ERCP检查均无胆道狭窄、胆道结石等并发症发生。结论:LC术后胆漏是常见但严重的并发症,术前术者应对手术难度与问题有充分的认识,规避不必要的风险,重在预防。术中仔细辨别分离胆囊三角,术后并发胆漏时,尽快予以经内镜胆汁引流是较好的有效诊治方法。     

腹腔镜胆囊切除术后胆囊管结石残留的预防及处理

目的 探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）术后胆囊管结石残留的预防及处理.方法 回顾性分析自2004年5月至2012年12月间共成功施行4 751例LC的临床资料.结果 135例LC术中采用胆囊管远端紧靠壶腹部施夹钛夹、切开胆囊管、自近端向远端挤压法取出胆囊管结石;其余4 616例中,12例术后发生胆囊管结石残留,4例经再次腹腔镜手术、8例经开腹手术成功取石,未再发生结石残留及其他严重并发症.结论 对胆囊管残余结石高风险病例,LC术中采用切开胆囊管、自近端向远端挤压法是预防术后胆囊管结石残留的有效方法.确诊LC术后胆囊管结石残留,应积极手术治疗,选择合适的病例再次经腹腔镜手术取出结石是安全可行的.     

腹腔镜胆囊切除术中胆囊破裂的临床分析(附305例报告)

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中胆囊破裂的原因及处理措施。方法:回顾分析2007年10月至2011年10月LC术中305例患者发生胆囊破裂的临床资料。结果:术中选择性胆囊破裂195例,包括胆囊穿刺抽吸减压104例,胆囊萎缩部分切除76例,胆囊造瘘15例;术中胆囊意外破裂110例,包括解剖胆囊时抓破36例,胆囊床剥离时破裂45例,胆囊取出时破裂29例。136例行腹腔冲洗,125例放置腹腔引流。术后发生膈下积液1例、胆囊窝积液3例、脐部切口感染4例、脐部切口结石残留并感染1例,余均无腹腔内感染、脓肿及败血症等并发症发生。结论:选择性胆囊破裂利于手术的顺利完成,提高手术技巧并选择合适的病例可避免胆囊意外破裂,正确处理破裂胆囊可减少并发症的发生。     

Retained abdominal gallstones during laparoscopic cholecystectomy

BACKGROUND: Although gallbladder perforation with spillage of bile and gallstones is quite common, the approach to retained gallstones in the abdomen still is controversial. METHODS: Laparoscopic cholecystectomy (LC) was performed on 580 patients with gallstones. In 101 (17%) patients, gallbladder perforations occurred during surgery, and in 43 (7%) patients, stone(s) were spilled into the peritoneal cavity. In 24 (4%) patients, gallstone(s) were not cleared entirely from the peritoneal cavity. These patients were invited to return for physical examination and biochemical tests. To investigate the retained abdominal gallstone(s) computed tomography was performed. RESULTS: Twenty-two patients were investigated. After a median follow-up period of 121 months, retained abdominal gallstone(s) were shown in 2 patients by computed tomography. Biochemical tests were normal except in 1 patient with chronic hepatitis. All of the patients were happy with their surgical results. CONCLUSIONS: This study revealed no harm caused by retained abdominal gallstone(s) during LC after long-term follow-up evaluation.     

腹腔镜胆囊切除术后腹腔遗留胆石的临床表现和治疗(附1例报告并文献复习)

腹腔镜胆囊切除时,胆囊穿破、胆汁和胆石泄漏入腹腔较为常见,需及时清除。一旦遗留结石在腹腔,可能引起脓肿形成等并发症,需再次手术治疗。现报告1例LC后遗留3cm直径结石于腹腔引起脓肿的临床表现和治疗,并对近期国外文献报告的32例有关资料作了简要复习,并对LC后腹腔遗留胆石并发症的临床表现、诊断和治疗提出了初步意见。     

Abdominal wall abscess following laparoscopic cholecystectomy: an unusual late complication of lost gallstones

Laparoscopic cholecystectomy (LC) is associated with a significant risk of gallbladder perforation with spillage of bile and stones into the peritoneal cavity. The retrieval of the spilled stones is not always possible by laparoscopic technique. Majority of these cases do not have any problem in future but sometimes the lost stones lead to serious complications. The authors present a case of lost gallstones, which resulted into an abdominal wall abscess and discharging sinus 9 years after LC. This late presentation is among the very few reports after LC. Risk factors for gallbladder perforation, various techniques to avoid spillage of stones, possible complications and their management is discussed.     

Dropped Gallstones During Laparoscopic Cholesystectomy: The Consequences

During laparoscopic cholecystectomy, gallbladder perforation has been reported, leading to bile leak and spillage of gallstones into the peritoneum. Because the consequences can be dangerous, conversion to laparotomy as an instant management for gallstone spillage is one of the topics of current discussion in laparoscopic cholesystectomy. In this article, we discussed the option of not converting to laparotomy after intraperitoneal gallstone spillage as an acceptable approach to management or not.A prospectively maintained database of 1528 consecutive laparoscopic cholecystectomies performed during a 10-year period at the 4th Surgical Clinic of The Ankara Numune Education and Research Hospital was analyzed. Perforations resulting in gallstone spillage into the abdominal cavity were documented in 58 (3.8%) patients. Among those 58 patients seven (12%) experienced complications from retained stones. To maintain acceptable management of such patients, surgeons should inform each patient preoperatively that stones may be spilled. In the event of spillage, the patient should be informed postoperatively, and followed closely for complications. Follow-up should not waste time and money with unnecessary examinations, and it should avoid psychological trauma to the patient with a wrong diagnosis of cancer as a stone may mimic cancer radiologically. Thus the surgeon should not hesitate to record the events and inform the patient about the spillage of the stones and possible consequences.     

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.     

The fate of the dropped gallstones during laparoscopic cholecystectomy

Stones can be spilled from the gallbladder during laparoscopic cholecystectomy. These stones can be left in the peritoneal cavity or trapped at the trocar site. The potential late sequel and associated morbidity are not well documented. We reviewed the records of four patients who underwent laparoscopic cholecystectomy at Mount Sinai Medical Center in New York City who suffered from late complications attributed to gallstones left in the peritoneal cavity or abdominal wall. Four patients presented 1–14 months after laparoscopic cholecystectomy with intraabdominal and abdominal wall abscesses. The spillage of gallstones was noticed during the initial operation only in one of the patients. Three patients required laparotomy and open drainage of intraabdominal abscesses with drainage of pus and gallstones after failed attempts at percutaneous drainage. Two patients underwent local exploration of an abdominal wall abscess containing stones. Stones left in the abdominal cavity or trapped in trocar sites after laparoscopic cholecystectomy can cause serious late complications requiring repeated surgical interventions. Every effort should be made in order to avoid spillage of stones during dissection of the gallbladder and cystic duct and during retrieval of the gallbladder through the abdominal wall. Received: 10 January 1996/Accepted: 2 April 1997     

Complications due to gallstones lost during laparoscopic cholecystectomy

Background: The aim of this study was to identify predisposing factors for complications after gallstone spillage during laparoscopic cholecystectomy (LC). Methods: Papers derived from Medline search and papers from reference lists within these papers were studied. Ninety-one reports on complications caused by lost gallstones published between 1991 and 1998 were analyzed. These patients were compared with cases in published series on LC in general. Results: Gallbladder perforation (20%) and stone spillage (9%) were the two most common complications of LC which occurred during the dissection (75%) and removal (25%) of the gallbladder. Predisposing factors for developing complications after stone spillage were: older age, male sex, acute cholecystitis, spillage of pigment stones, number of stones (>15) or size of the stone (Ø > 1.5 cm), and perihepatic localization of lost stones. CT-scan and ultrasound examination proved best for the recognition of complications caused by lost stones. Explorative laparotomy and surgical removal of the stones was the most frequently used therapy. Conclusions: Gallbladder perforation and stone spillage might cause hazardous complications. In cases with loss of numerous or large pigment stones which cannot be retrieved by laparoscopy, intraoperative conversion to open surgery can be justified.