腹腔镜胆囊切除术后再手术19例临床分析

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)后因各种并发症而再次行开腹手术或腹腔镜手术的原因、诊断方法、治疗措施及预后。方法:回顾分析1994年6月至2011年6月19例LC患者术后再次手术的临床资料。结果:19例再次手术的患者中,胆囊管残端钛夹脱落2例,胆囊管残端局部坏死3例,副肝管及右肝管分支裂伤各1例,胆囊床毛细胆管渗漏2例,胆管炎性狭窄2例,胆囊动脉出血2例,腹壁戳孔小动脉出血引发巨大血肿1例,胃穿孔1例,小肠脐部切口疝回纳后挫伤回肠壁形成血肿致小肠梗阻1例,术中遗漏胃角后壁、结肠肝曲及直肠癌各1例。患者经再次手术后均痊愈出院,随访3～12年,无任何后遗症发生。结论:术前全面采集、详细分析病史,通过影像学资料评估患者胆道情况,术中遵循LC操作原则,可降低并发症发生率及再手术率。

Clinical analysis of 19 cases of reoperation after laparoscopic cholecystectomy

Objective:To investigate the causes,treatment and prognosis of reoperation cases after laparoscopic cholecystectomy.Methods:A retrospective analysis was made on the clinical data of the 19 reoperation patients after LC in 6 823 patients from Jun.1994 to Jun.2011.Results:In 19 cases of reoperation patients cystic duct stump titanium clip off was found in 2 cases,partial necrosis of the cystic duct stump occurred in 3 cases,accessory hepatic duct and right hepatic duct laceration occurred in 1 patient respectively,the cholangioles leakage in 2 cases,inflammatory bile dult stenosis in 2 cases,the cystic artery bleeding in 2 cases,abdominal lincision arterial bleeding caused a huge hematoma in 1 case,stomach perforation in 1 case,umbilical hernia resulted in intestinal obstruction in 1 case,omission of gastric angle cancer,hepatic flexure of colon cancer and rectal cancer in 1 case respectively.All cases were discharged after the second operation,during the follow-up of 3 to 12 years,no comlications were found.Conclusions:It may reduce the rate of LC complications and reoperation by preoperative comprehensive collection and detailed analysis of the medical history,the proper assessment of the biliary anatomy through the patient image data and the right principles of LC during operation.