腹腔镜胆囊切除术中变异胆囊动脉出血的预防与处理

目的探讨腹腔镜胆囊切除术（1aparoscopic cholecystectomy，LC）中变异胆囊动脉出血的预防与处理措施。方法2001年3月-2013年10月我院行LC8016例，其中21例发生变异胆囊动脉出血，术中采用电凝止血、钛夹夹闭、压迫止血以及中转开腹止血等方法处理。结果胆囊动脉变异情况：位于胆囊三角内13例，表现为胆囊动脉分为前后两支或双胆囊动脉12例，三支胆囊动脉1例；位于胆囊三角外7例，其中紧贴胆囊管后方上行4例，紧贴胆囊管前方上行1例，来自胃十二指肠动脉与变异右肝动脉各1例；胆囊动脉同时出现于胆囊三角内外1例，该例一支动脉为典型胆囊动脉，另一支位于胆囊管浅表。18例在腹腔镜下成功止血，3例止血困难中转开腹后成功止血。术后住院时间3～9d，平均4．8d。21例术后随访2—6个月，平均3个月，无胆管损伤、继发出血、腹腔感染等并发症。结论胆囊动脉变异常见，Lc术中精细解剖、准确辨认、妥善处理，对预防LC术中变异胆囊动脉出血有重要意义。

Prevention and Management of Hemorrhage from Abnormal Cystic Artery During Laparoscopic Cholecystectomy

Objective To explore the prevention and management of hemorrhage from abnormal cystic artery during laparoscopic cholecystectomy （LC）. Methods The clinical data of 8016 patients who underwent LC from March 2001 to October 2013 in this hospital were retrospectively analyzed. Bleeding of abnormal cystic artery occurred in 21 cases. Electronic coagulation, titanium clipping, compression hemostasis, and conversion to laparotomy were used to control the hemorrhage. Results The abnormal cystic artery was located in the Calot Triangle in 13 cases, of which two branches or double cystic arteries were found in 12 cases and three cystic arteries in 1 case. The abnormal cystic artery was located outside the Calot Triangle in 7 cases, of which adjacency to the rear part of the cystic duct was seen in 4 cases, adjacency to the front surface of the cystic duct in 1 case, originating from gastroduodenal artery in 1 case, and originating from abnormal right hepatic artery in 1 case. The cystic artery was located both in and outside the Calot Triangle in 1 case, with one branch at normal site and the other branch on the surface of the cystic duct. Bleeding was successfully controlled under laparoscope in 18 cases, while a conversion to laparotomy for hemostasis was carried out in 3 cases. The mean postoperative hospital stay was 4.8 days （ range, 3 - 9 days）. The 21 patients were followed up for 2 - 6 months with a mean of 3 months. No complications such as cystic duct injury, secondary hemorrhage, or intra-abdominal infection were found after operation. Conclusions The anatomical variations of cystic artery are not seldom seen. Careful separation, accurate judgment and management are the key to the prevention of hemorrhage during LC.