腹腔镜胆囊切除术中胆囊破裂的临床分析(附305例报告)

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中胆囊破裂的原因及处理措施。方法:回顾分析2007年10月至2011年10月LC术中305例患者发生胆囊破裂的临床资料。结果:术中选择性胆囊破裂195例,包括胆囊穿刺抽吸减压104例,胆囊萎缩部分切除76例,胆囊造瘘15例;术中胆囊意外破裂110例,包括解剖胆囊时抓破36例,胆囊床剥离时破裂45例,胆囊取出时破裂29例。136例行腹腔冲洗,125例放置腹腔引流。术后发生膈下积液1例、胆囊窝积液3例、脐部切口感染4例、脐部切口结石残留并感染1例,余均无腹腔内感染、脓肿及败血症等并发症发生。结论:选择性胆囊破裂利于手术的顺利完成,提高手术技巧并选择合适的病例可避免胆囊意外破裂,正确处理破裂胆囊可减少并发症的发生。

Clinical analysis of gallbladder perforation in 305 patients undergoing laparoscopic cholecystectomy

Objective:To investigate the causes and treatments of gallbladder perforation in patients undergoing laparoscopic cholecystectomy.Methods:The clinical data of 305 patients who encountered gallbladder perforation during laparoscopic cholecystectomy from Oct.2007 to Oct.2011 were retrospectively analyzed.Results:In the 305 patients undergoing laparoscopic cholecystectomy,195 cases experienced selective gallbladder perforation,including 104 cases with gallbladder puncture and aspiration for decompression,76 with resection of atrophic part and 15 with cholecystostomy;and the other 110 cases experienced accidental gallbladder perforation,including 36 cases with perforation happened during the dissection of the gallbladder,45 happened during gallbladder bed dissection and 29 happened during gallbladder removal.Of all the patients,136 cases were treated with peritoneal lavage and 125 cases with abdominal drainage.Of all the patients,1 case complicated with subdiaphragmatic effusion,3 with gallbladder fossa fluid,4 with infection in the umbilical puncture position,1 with residual stones combined with infection in the umbilical puncture position,and the other cases complicated with no intra-abdominal infections,abscess or septicemia.Conclusions:Selective gallbladder perforation method facilitates completing the operations.To avoid unexpected gallbladder perforation,the operational skills should be improved and suitable patients should be selected.And the right treatment with gallbladder perforation can reduce its complications.