腹腔镜胆囊切除术术后腹腔积液的原因分析

目的 :研究腹腔镜胆囊切除术 (L C)术后腹腔积液 (HA)的发生率、发生原因、致病因素 ,以进一步防治 L C术后 HA。方法 :回顾性分析 1478例择期 L C患者 ,研究其年龄、性别、年度、手术时间、术者经验、术中胆汁污染、术中戊二醛污染对术后 HA发病率的影响。结果 :L C术后 HA共 16 9例 ,发病率为 11.4%。HA的发病率与受术者的年龄、性别无关。 1996年以后 HA的发病率有明显降低。手术时间长 HA发病率高。手术者 1例～ 2 5例和 76例～ 10 0例 L C的 HA发病率有明显差别。术中的胆汁污染、戊二醛污染导致 HA发病率增加。结论 :L C术后 HA的发生与多种因素有关 ,胆汁污染和戊二醛污染可能是主要致病因素。可以据此对 L C术后 HA进行有效地预防。

The Etiologic Study of Postoperative Hydrops Abdominis Subsequent to the Laparoscopic Chelocystectomy

Objective:Postoperative hydrops abdominis(HA) is one of most common complication in the patients who underwent the laparoscopic chelocystectomy(LC),Its etiology is still unknown.The aim of this study was to find the causes of HA in the related factors in the perioperation period.Methods:We retrospectively reviewed our 1478 patients who underwent LC from 1990 to 1998,and analysed the average annual morbidity of HA and the relationships between age,sex,operation time,experience of operator,intraoperative bile pollution,intraoperative glutaraldehyde pollution and morbidity of HA subsequent to LC.Results:169 cases of HA were found in this group,the morbidity was 11.4%.The morbidity was unrelated to the patient's age and sex.When operative time was more than 60min,HA morbidity was as high as 23.4%.There was significant different morbidity between first 25 cases and fourth 25 cases in the same 4 operators.The morbidity in the group of bile pollution was significantly higher than in the group of no bile pollution.HA had decreased since 1996,And the removal of glutaraldehyde had led to decrease the morbidity of HA in the fully cleaning period.Conclusion:The causes of HA subsequent to LC was various and complicated,bile and glutaraldehyde pollution may be the important factor.