腹腔镜胆道手术并发症的腹腔镜处理体会:附17例临床报告

目的 探讨腹腔镜胆道手术并发症的同期或再次腹腔镜下处理的可行性和有效性.方法 对17例腹腔镜胆道手术并发症经腹腔镜下处理的方法 和结果 进行总结分析.结果 术中发现肝总管损伤3例,胆囊床肝中静脉损伤出血3例,胆囊管残端同缩和十二指肠损伤各1例;术后发现胆漏6例,胆囊床和胆囊动脉出血各1例,戳孔疝1例.该组病例均经同期或再次腹腔镜处理治愈,未增加腹部戳孔,术后平均住院3.7 d.胆管修复者平均随访7.7个月,无胆管狭窄发生.结论 腹腔镜胆道手术并发症,对已掌握丰富微创技术者,大多数能在腹腔镜下获得安全、有效处理.

Experience in laparoscopic management of complications after laparoscopic biliary operation: a report of 17 cases

Objective To investigate the feasibility and effectiveness of laparoscopy on compli-cations during or after laparoscopic biliary operation. Methods Data were collected from 17 patients with laparoscopic biliary operation complications. The methods and results of the management of lapa-roseopy were analyzed. Results All complications were treated successfully by laparoscopy. The in-juries recognized intraoperatively included penetrating common hepatic duct trauma in 3 patients, gall-bladder bed vein bleeding in 3, cystic duct remnant retraction in 1 and duodenal injury in 1. The com-plications found postoperatively was bile leakage in 6 patients. The other 3 patients had gallbladder bed bleeding, gallbladder artery bleeding and abdominal wall hernia, respectively. The average dura-tion of hospitalization was 3.7 d after operation. The abdominal incision was not added and no bile duct stricture has been detected 7.7 months after the bile duct repair. Conclusion Most of the com-plications after laparoscopic biliary operation can be treated by laparoscopy safely and effectively.