腹腔镜胆囊切除术后腹膜炎的原因及处理对策

目的 探讨腹腔镜胆囊切除术(Laparoscopic Cholecystectomy,LC)后急性腹膜炎发生的原因及处理措施。方法对11000例LC术后急性腹膜炎病例进行回顾分析。结果 本组病例LC术后共16例(0.15％)发生了腹膜炎。其中胆道损伤引起的腹膜炎9例(56.2％),胆囊动脉或分支出血引起的腹膜炎5例(31.4％),十二指肠损伤引起的腹膜炎2例(12.5％),均经外科手术治愈,除1例胆肠吻合术后出现吻合口狭窄经再手术治愈外,无其它并发症。结论 胆漏是LC术后腹膜炎的主要原因;其次为胆囊动脉或其分支出血,消化道损伤虽所占比例较少,但其临床症状重,感染性休克出现早,更应引起临床医师的重视。

The cause and administrative strategy of acute peritonitis on the post-laparoscopic cholecystectomy

Objective To investigate the cause and managed procedure of acute peritonitis post laparo-scopic cholecgstectomy (LC) . Methods From September 1991 to May 2002, 11000 cases with post LC were analyzed retrospectively. Results 16 cases of acute peritonitis of post LC were found in this group (0. 15% ), Among of them, acute peritonitis caused by biliary tract injury accounted for 9 cases (56. 2% ) . Acute peritonitis resulted from cystic artery or its branch injury in 5 cases (31. 4% ) Acute peritonitis due to duodenal injury had 2 cases (12. 5%). All cases of complications were cured by surgical management. Follow up 1-8 years, only one case oceured anastornotic stoma stenosis after choledochojejunostomy, which it was cured by reoperation. Conclusion Bile leakage is main cause of peritonitis of post LC. The second cause is cystic artery or its branch traumatic bleeding. Acute peritonitis of post LC caused by digestive tract injury is uncommon, but it has a severe clinical symptoms and signs, and septic shock occur early. So, special attention must be given to the clinical surgeon.