腹腔镜胆囊切除术后腹部及肩背部不适原因与处理

目的:总结腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)术后腹部及肩背部疼痛的原因及处理措施。方法:回顾分析31例LC术后腹部及肩背部疼痛患者的临床资料,总结其原因及相应处理措施。结果:31例患者中胃溃疡2例,胃癌1例,肝内胆管结石3例,胰腺假性囊肿1例,肠粘连2例,切口疝1例,肋弓下切口疼痛10例,胆囊窝积液8例(腹腔脓肿1例,胆囊床迷走胆管漏1例,胆囊床渗血1例,肝中静脉损伤1例,胆汁外溢4例),胆囊切除术后综合征3例。结论:术前完善检查、术中仔细操作减少不必要的副损伤、术后积极治疗,LC术后疼痛是完全可避免的。

Analysis of causes and the treatment of discomfort from abdomen,shoulder and back after laparoscopic cholecystectomy

Objective:To analyze the causes of pain at abdomen,shoulder and back after laparoscopic cholecystectomy(LC).Methods:The clinical data of 31 cases with postoperative abdomen,shoulder and back pain after LC were analyzed retrospectively,the reasons of postoperative abdomen,shoulder and back pain,and the corresponding treatment measures were summarized.Results:Among all the 31 patients who suffered from pain after LC,there were two cases of gastric ulcer,one case of gastric cancer,three cases of intrahepatic bile duct calculus,one case of pancreatic pseudocyst,two cases of postoperative intestinal adhesion,one case of port site hernia,ten cases of incisional pain below the costal arch,eight cases of gallbladder fossa effusion(one case of intra-abdominal abscess,one case of aberrant duct leakage at gallbladder bed,one case of gallbladder bed bleeding,one case of middle hepatic vein injury,four cases of bile leakage),three cases of post-cholecystectomy syndrome.All the complications could be prevented and treated by positive measures.Conclusions:Through improving the pre-operative examination,careful operating to reduce unnecessary secondary injury and positive postoperative treatment,the pain after LC is completely avoidable.