腹腔镜胆囊切除术后19例梗阻性黄疸原因分析

腹腔镜胆囊切除（laparoscopiccholecystectomy,LC）已成为良性胆囊疾病手术首选方式。但LC术后可发生多种并发症,围手术期黄疸是常见并发症之一,其中梗阻性黄疸大多需外科处理。我院1997年6月—2009年12月,救治此类患者19例,现将临床资料分析如下。     

腹腔镜胆囊切除术后黄疸六例诊治体会

腹腔镜切除胆囊术后黄疸的处理甚为重要.我院2005年4月至2008年7月共行腹腔镜胆囊切除术1200余例,术后发现黄疸6例,现报告如下. 临床资料 1.一般资料:男4例,女2例,年龄38～58岁,平均48岁.入院均行腹部超声检查提示:胆囊结石,胆囊炎急性期,胆管未见异常.入院当日肝功能各项指标正常.抗炎治疗2～5 d后均行腹腔镜胆囊切除术.术后8～72 h后出现黄疸,2例行ERCP检查,其中1例发现胆总管内泥沙样结石,另1例由于生物夹过度钳夹致胆总管狭窄.2例行二次手术,其中1例发现胆囊结石落入胆总管引起黄疸,另1例术中发现肝总管被横断.2例复查B超和CT,其中1例提示胰腺炎,另1例考虑胆管炎.     

腹腔镜胆囊切除术后黄疸原因分析

目的探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）后黄疸的原因及防治方法。方法总结LC后并发20例黄疸的诊治经验。结果LC后20例黄疸病例中胆管残留结石9例,肝外胆管损伤4例,胆囊床毛细胆管漏3例,肝细胞损害致肝功能下降2例,胆管炎1例,胆管癌1例,均经相应治疗痊愈出院。结论术前详细全面的检查以明确诊断、规范的操作程序、熟练的操作技巧及适时中转开腹是避免此并发症的关键,强调对发生黄疸病例的处理个体化。     

腹腔镜胆囊切除术后黄疸的分析及处理

目的 探讨腹腔镜胆囊切除术(LC)后黄疸的原因及治疗方法。方法 回顾性分析1995年10月～2001年12月施行LC术2047例中11例术后黄疸的原因及处理。结果 本组术后黄疸的发生率为0．54％(11／2047)，原因为胆漏(5／11，45．4％)、胆总管结石残留(2／11，18．2％)、急性胰腺炎(2／11，18．2％)、胆管炎性狭窄(1／11，9．1％)及急性肝功能损害(1／11，9．1％)。分别采用内镜下手术、开腹手术和保守治疗，取得满意疗效。结论 LC术后黄疸原因以胆漏及胆总管结石残留最为常见，及时对因处理可有效解除症状。     

腹腔镜胆囊切除术后黄疸的原因及对策

目的 :探讨腹腔镜胆囊切除术 (LC)术后黄疸的原因、预防措施及处理方法。方法 :回顾分析12 5 6 0例LC术后发生黄疸的 2 3例 (0 18% )临床资料。结果 :本组术后 2 3例黄疸中胆管损伤 9例 ,胆道结石6例 ,急性肝炎 2例 ,胆源性胰腺炎 2例 ,溶血性疾病 1例 ,肝癌 1例 ,药物性黄疸 2例。除 1例死于肝癌外 ,余均痊愈 ,其中 13例非手术治愈 ,9例手术治疗痊愈。结论 :LC后黄疸原因复杂 ,胆管损伤和胆道结石是其主要原因 ;在诊治LC的过程中术前严格检查 ,手术程序规范 ,可减少LC后黄疸发生率。     

腹腔镜胆囊切除术后黄疸46例临床分析

目的探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)后黄疸发生的原因与防治。方法回顾分析1992年1月~2009年7月8260例LC中46例术后出现黄疸的临床资料。结果 17例LC术后1~3 d发生黄疸,经保守治疗治愈。15例术后4~9 d发生黄疸,经内镜治疗治愈。12例术后7~12 d发生黄疸,经1~2次开腹手术治愈。2例急诊开腹手术,分别于二次手术后24、49 h多脏器衰竭死亡。治愈44例随访1~17年,7年,恢复良好。治愈率95.8%(44/46),病死率4.2%(2/46)。结论 LC术后黄疸是胆管损伤的主要症状,但不一定都是胆管损伤。详细掌握病情,严格LC适应证,把握手术时机,规范手术操作与围手术期处理是防治LC术后黄疸的有效措施。     

腹腔镜胆囊切除术后非损伤性黄疸的诊治体会

随着腹腔镜胆囊切除术（LC）的广泛应用,LC术后黄疸引起人们越来越多的重视。除常见的损伤性黄疸外,非损伤性黄疸亦不少见。我科自2002年1月至2009年12月因胆囊结石行单纯腹腔镜胆囊切除术病人共2356例,其中26例术后经诊治后证实为非损伤性黄疸,报告如下。1临床资料1.1一般资料本组26例（1.1%）病人中男性8例,女性18例。年龄37～75岁。所有病人术前腹部超声均提示胆囊结石,胆总管未见结石及扩张     

腹腔镜胆囊切除术后黄疸的原因与预防

目的探讨腹腔镜胆囊切除术（LC）后黄疽的原因及预防。方法对13例LC术后并发黄疸患者的诊治情况作回顾性分析。结果LC术后胆管残留结石8例,肝外胆管损伤伴胆漏3例,肝炎活动肝细胞性黄疽1例,胆囊颈部癌遗漏肿瘤复发胆管梗阻黄疸1例,均经相应治疗后康复出院。结论胆管残留结石是LC术后黄疸最常见原因,术前全面评估以及术中的规范操作是预防LC术后黄疸的关键。     

腹腔镜胆囊切除术后外科黄疸(附16例分析)

目的探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)后外科黄疸的原因、治疗及预防措施. 方法对我院1994年1月～2002年1月3 092例LC中14例外科黄疸及外院转入2例共16例进行回顾性分析. 结果 16例中9例胆石残留,7例胆管损伤,包括2例胆囊管漏,3例胆(肝)总管损伤,2例迷走胆管漏后二次黄疸.16例均经手术治愈,无胆道狭窄发生. 结论减少LC术后外科黄疸的关键在于掌握好LC的手术适应证,规范手术操作,发生外科黄疸应积极手术治疗.     

腹腔镜胆囊切除术后胆漏的微创治疗

目的探讨腹腔镜胆囊切除术后胆漏的微创治疗方法。方法回顾近5年来腹腔镜胆囊切除术后胆漏35例。B超、CT引导下抽取腹腔积液后放置腹腔引流管8例,腹腔镜下修补缝合18例,十二指肠镜下放置鼻胆管9例。结果 2例发生胆管狭窄,行胆肠吻合术顺利恢复,其余病例恢复良好。结论微创治疗对于部分腹腔镜胆囊切除术后胆漏是安全有效的,必要时也为下一步手术创造条件。     

LAPAROSCOPIC MANAGEMENT OF COMPLICATIONS FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY

Laparoscopic cholecystectomy has rapidly become the treatment of choice for symptomatic cholelithiasis. Although published morbidity and mortality rates compare favourably with open cholecystectomy, bile duct injuries occur far more frequently and technical complications unique to the laparoscopic approach account for a significant number of postoperative deaths. The majority of these complications are dealt with by laparotomy. Two technical complications encountered in a series of 170 patients undergoing laparoscopic cholecystectomy and their subsequent management are presented. One patient suffered a diathermy injury to the common hepatic duct and postoperative bile leak. This was managed successfully by repeat laparoscopy and peritoneal lavage combined with endoscopic retrograde cholangiopancreatography (ERCP) and stenting of the hepatic duct. Another patient sustained a perforated duodenum complicated by peritonitis, subcutaneous wound infection and generalized sepsis. The perforation was repaired at a second laparoscopy using intracorporeal suturing and Tissucol. It is demonstrated that it is possible to deal with some of the technical complications of laparoscopic cholecystectomy with a combination of minimally invasive techniques, sparing the patient from the additional risk of laparotomy.     

LAPAROSCOPIC CHOLECYSTECTOMY: THE MISSED DIAGNOSIS

Background : All 534 laparoscopic cholecystectomies performed by five surgeons at a single institution over a 3-year period were reviewed as part of a quality assurance process. The aim of the review, which has previously been published in this journal, was to identify and quantify complications of the procedure. Five cases in this series were recognized where major intra-abdominal pathology not identified at the time of laparoscopic cholecystectomy required laparotomy shortly thereafter. These five cases are reported here because there has been little discussion in the literature of this problem associated with laparoscopic cholecystectomy. Methods : The records of all 534 patients having a laparoscopic cholecystectomy between October 1990 and September 1993 were reviewed and entered into a computer database (Microsoft Access). This data collection and recording have subsequently become an ongoing process of quality assurance. Results : Five of 534 patients treated by laparoscopic cholecystectomy failed to have resolution of their symptoms post-operatively. A laparotomy was subsequently required within 3–12 months which demonstrated causative pathology present, but not detected at, the time of laparoscopic cholecystectomy. Where possible, treatment of these laparotomy findings resolved the initial presenting symptoms of colicky epigastric pain. Conclusions : The rate of ‘missed diagnosis’ is found to be < 1%. Laparoscopic cholecystectomy is a therapeutic, rather than diagnostic, procedure, and pre-operative discussion should include the possibility of further procedures being required subsequently, particularly when symptoms and signs are atypical.     

INTRAPERITONEAL GALLSTONE-RELATED SINUS FORMATION FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY

We report a single case of gallstone related sinus formation through the midclavicular trocar port after a laparoscopic cholecystectomy in a 77 year old woman.     

腹腔镜胆囊切除术肠道损伤的原因及防治措施

目的探讨腹腔镜胆囊切除术(LC)肠道损伤的原因、预防措施及处理方法。方法回顾分析14例LC术中肠道损伤的原因及处理方法。其中术中发现11例,术后发现3例,术中发现者,除1例肠系膜血肿行保守治疗外,余10例十二指肠、空肠、回肠及结肠损伤者均在腹腔镜下或中转开腹行损伤脏器修补术,其中1例十二指肠穿孔因原修补处出现肠漏再次开腹行高位空肠造瘘充分引流,1例结肠贯通伤因术中只修补了一侧而于术后第3天开腹探查修补对侧并于第2次术后第5天出现修补处肠漏再次开腹行蕈形管造瘘术。术后发现的3例患者均剖腹探查行漏口修补或造瘘引流术。结果 14例患者中,13例恢复良好,行第3次手术的患者发生了低蛋白血症和ARDS,经积极治疗后恢复正常,14例患者均治愈出院。结论 LC术中胆囊周围炎性粘连、电凝钩反弹是发生肠道损伤的主要原因,术中及时发现损伤并妥善处理是改善患者预后的关键。     

A SIMPLE AND SAFE TECHNIQUE FOR DRAINAGE TUBE INSERTION AFTER LAPAROSCOPIC CHOLECYSTECTOMY

A technique is described which facilitates the simple and safe placement of virtually any type of drain tube, when indicated, after laparoscopic cholecystectomy.     

腹腔镜胆囊切除术后胆漏的处理

目的探讨腹腔镜胆囊切除术（Laparoscopic Cholecystectomy,LC）术后胆漏的各种处理方式。方法回顾性分析我院2000年2月-2005年5月施行的LC3868例。结果术后发生胆漏22例,胆漏发生率为0.56%。所有胆漏患者经保守治疗、再次腹腔镜探查置管、内镜治疗和腹腔引流管充分引流后造影拔管治疗。结论非主胆道损伤所引起的胆漏多可经非开腹手术治疗而治愈。     

胆囊结石合并肝硬化的腹腔镜治疗分析

目的探讨肝硬化患者腹腔镜胆囊切除术的可行性、安全性及手术技术特点。方法回顾分析我院自1991年3月至2007年3月间,240例Child A、B级肝硬化患者腹腔镜胆囊切除术的临床资料。结果LC成功224例,中转开腹16例。中转原因:结石嵌顿,Calot三角粘连10例;术中出血,镜下止血困难4例;术中发现胆道变异2例。LC手术时间40.3±12.5min,术中出血60.8±19.5 ml,术中无损伤;术后出血2例,肺部感染2例,泌尿系感染2例。无肝功能衰竭等严重并发症,均治愈出院。术后住院日5.2±2.0 d。结论对于Child A、B级肝硬化患者,腹腔镜胆囊切除术是一种安全可行的微创手术。     

腹腔镜治疗结石嵌顿性胆囊炎96例临床分析

目的探讨结石嵌顿性胆囊炎腹腔镜胆囊切除术(LC)的可行性及手术方法。方法回顾分析96例结石嵌顿性胆囊炎行LC的临床资料。结果92例完成LC,4例中转开腹,2例发生胆瘘,无胆管损伤。结论结石嵌顿性胆囊炎行LC是安全可行的。     

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY

Laparoscopic cholecystectomy is the preferred method of treatment for symptomatic choledocholithiasis. Since its introduction there has been an increase in postoperative diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to assess the indications and results of ERCP following laparoscopic cholecystectomy. Sixty-one patients had an ERCP following laparoscopic cholecystectomy. Two broad groups were identified: Group 1 (35 patients) had filling defects (consistent with stones) noted on operative cholangiography, which were not successfully flushed or extracted at the time of laparoscopic cholecystectomy; Group 2 consisted of patients who developed problems following laparoscopic cholecystectomy. Nine patients had post-laparoscopic cholecystectomy pain with abnormal liver function tests (LFT), four of whom had common bile duct (CBD) injuries and three had CBD stones. Eleven patients had post-laparoscopic cholecystectomy pain with a normal diameter common bile duct on ultrasound and normal LFT; only one had a CBD stone. Five patients with a persisting bile leak following laparoscopic cholecystectomy had an ERCP and endoscopic sphincterotomy. In three the leak ceased, while two required subsequent open surgery to drain bile collections and ligate the cystic duct. One patient presented with an episode of transient jaundice but had a normal ERCP. There were six post-ERCP complications; three patients had mild pancreatitis, two had a minor haemorrhage and one an asymptomatic duodenal perforation. Endoscopic retrograde cholangiopancreatography post-laparoscopic cholecystectomy was most valuable for the management of retained stones and the diagnosis and management of post-laparoscopic cholecystectomy pain in association with abnormal LFT. The diagnostic yield was low (9%) when the LFT were normal.     

腹腔镜胆囊切除术严重并发症的防治（附30例报告）

目的：探讨LC严重并发症的防治措施。方法：方法：回顾性分析30例LC手术严重并发症的原因及处理，结论：未遵循规范化手术原则可导致并发症发生，腹腔镜手术可处理大部分出血及胆瘘患者，胆管损伤是处理最棘手的并发症。结论：遵循手术规范化原则可减少并发症发生。腹腔镜手术是处理出血及胆瘘的主要措施，胆道损伤的处理应极其慎重。