腹腔镜胆囊切除术并发症预防与处理

目的：探讨腹腔镜胆囊切除术（LC）并发症的预防及处理方法。方法：回顾性分析1318例LC的临床资料，总结并发症发生的原因以及预防和处理方法。结果：因Calot三角致密黏连、急性炎症时组织结构辨认不清、解剖异常时的错误判断导致胆管损伤4例，均及时中转开腹修复，愈后良好。穿刺trocar损伤黏连于原手术切口处小肠1例，及时剖腹修补痊愈。术后网膜血管焦痂脱落出血1例。经腹腔镜下止血成功：脐部穿刺孔出血流入腹腔2例。经剖腹探查止血治愈：脐部穿刺孔出血致腹壁皮下血肿2例，经局部压迫治愈。术后胆漏1例，经剖腹结扎副肝管断端治愈。术后胆总管残余结石3例，2例经解痉治疗后结石排出，1例经内镜乳头肌切开（EST）取石治愈。结论：合理选择并发症的处理方法可减轻患者的痛苦。

Prevention and Management of Complication in Laparoscopic Cholecystectomy

Objective ：To investigate the prevention and management of complication in laparoscopic cholecystectomy. Methods：The clinical data of 1318 patients received LC was retrospectively analyzed from January 2006 to September 2008,and then sum up the reasons for complications as well as the prevention and treatment methods. Results ： Bile duct injury occurred in 4 cases due to severe adhesion in the region of Calot triangle,unclearly identifying the organizational structure with acute inflammation and incorrectly judging with abnormal anatomy in biliary system. All 4 patients were cured by conversioni open surgery of bile duct repair. Bowel which adhere to the original incision was injured by trocar occurred in 1 case, and was cured by open surgery of bowel repair. Intraabdominal hemorrhage occurred in 3 cases. Omentum hemorrhage after operation caused by eschar exfoliation was found in 1 case who was cured by hemostasia with laparoscope;puncture hole hemorrhage was found in 2 cases that were also cured by open surgery. Navel incision hematoma occurred in 2 cases which were cured by compression. Bile leakage occurred in 1 case, which was cured by open surgery to legate the broken ends of accessory hepatic duct. Residual calculi in common bile duct occurred in 3 cases, 1 patient was cured by EST, and others were cured by spasmolysis. Conclusion ：Processing risk consciousness, being familiar with varia- tion anatomy, perfecting examinations before operation and correctly dealing with abnormal situation are the key to the prevention of complication. A reasonable choice of treatment to complication can alleviate the suffering of patients.