腹腔镜胆囊切除术适应证与并发症的探讨：附3 002例报告

目的：探讨腹腔镜胆囊切除术（LC）的手术适应证及经验教训。方法：回顾性分析2003年1月—2008年12月3 002例LC患者的临床资料,对其诊断、手术经过及结果等情况进行分析。 结果：总体中转开腹率为3.63%,胆管损伤0.27%,肠管损伤0.07%,术后胆囊动脉出血0.07%。其中,急性胆囊炎及有上腹部手术史的中转开腹率分别为7.17%和13.2%,显著高于总体平均水平（P<0.01）,但均无胆管损伤患者。结论：急性胆囊炎及有腹部手术史者不是LC的禁忌证,高度重视胆囊三角的解剖,适时中转开腹是减少并发症的关键。对并发肠管损伤、胆道损伤及胆囊动脉出血者,术中及时发现和恰当处理治疗和降低并发症发生的关键。

Indications and complications of laparoscopic cholecystectomy: a report of 3 002 cases

ObjectiveTo investigate the indications, and experience of laparoscopic cholecystectomy (LC).
MethodsThe clinical data of 3002 cases of LC,from Jan. 2006 to Dec. 2008, were reviewed.
ResultsThe total rate of convertion to open surgery was 3.63%, biliary tract injury 0.27%, bowel injury 0.07%, and postoperative bleeding of cystic artery 0.07%. In patients with acute cholecystitis or with a past history of upper abdominal operation, the convertion rate was 7.17% and 13.2% respectively, which was significantly higher than the total convertion rate (P<0.01), but no biliary tract injury occurred in any of the cases.
ConclusionsAcute cholecystitis or history of upper abdominal operation should not be as contraindication for LC. High attention to dissection of Calot′s triangle and appropriate timing of conversion to open surgery are the key elements to decrease complications.The prompt discovery and appropriate treatment of intraoperative bowel and bile duct injury and bleeding of cystic artery are important facts for decreasing postoerative complications.