腹腔镜胆囊切除术后发生严重并发症的临床分析

目的：探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）后发生严重并发症的原因、治疗措施和经验教训。方法：分析2007年8月至2009年4月期间华西医院胆道外科收治的LC术后发生严重并发症的7例患者的临床资料。结果：2例继发性胆总管结石合并化脓性胆管炎患者,采用内镜下十二指肠乳头切开（endoscopicsphincterotomy,EST）取出结石;3例胆道损伤患者,均进行肝门胆管成形和肝总管空肠吻合术;1例绞窄性肠梗阻患者,切除坏死空肠管后,行空肠对端吻合术;以上6例患者均顺利出院,随访8～20个月,均生活良好。1例患者LC术后发生肺动脉栓塞,积极抢救后因呼吸衰竭而死亡。结论：术中仔细轻柔的操作以及辩清肝总管、胆总管与胆囊管的三者关系是预防LC术后发生严重并发症的关键。合理可行的治疗措施是提高发生并发症的患者生活质量的保障。LC术时,胆道外科医生思想上要高度重视,不可盲目追求速度,必要时及时中转开腹。

Clinical Analysis of Severe Complications after Laparoscopic Cholecystectomy

Objective：To investigate the causes and therapeutic measures and the experience and lesson of sever complications after laparoscopic cholecystectomy（LC）.Methods：Clinical data of 7 patients with severe complications after LC from August 2007 to April 2009 were analyzed retrospectively.The clinical data was got from biliary department of West China Hospital.Results：Two cases of secondary common bile duct stone with acute suppurative cholangitis got cured by endoscopic sphincterotomy.Three cases of severe bile duct injury after LC had stricture of the hilar bile duct,and all of the cases were performed Roux-en-Y hepaticojejunostomy with the diameter of stoma 2.0-3.0 centimeters. One case of strangulating intestinal obstruction was cured through jejunum end-to-end anastomosis after cutting off the necrotic jejunum.All of the above 6 patients recovered well.Following up for 8-20 months,all lived well. One patient got pulmonary embolism after LC and dead of respiratory failure after active rescue.Conclusion：Carefully making operation and distinguishing the relationship of hepatic bile duct and common bile duct and the duct of gallbladder are the key points to prevent sever complications during LC.Reasonable and feasible treatment is the ensurement of increasing the living quality of the patients with sever complications after LC.And the surgeons of biliary department must have a correct attitude toward LC and should concern think highly during LC and should not pursue speed blindly.In necessary,the operation of LC should be turned into open cholecystectomy.