腹腔镜胆囊切除术1787例临床分析

目的探讨开展腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）恰当的适应证，正确预防和处理并发症。方法收集1998-2005年的1787例LC手术的临床资料，回顾性分析行LC患者的原发疾病种类、手术引起的近期及远期并发症。结果1787例LC患者中最多的是慢性胆囊炎合并胆囊结石（1448例，占81．02％）；其次是急性胆囊炎伴胆囊结石（86例，占4．81％）。中转开腹手术12例，占0．67％。手术并发症中，最严重的为手术中胆管损伤，共2例，发生率为0．11％；术后胆漏2例，发生率为0．11％。晚期并发症包括胆总管残余结石6例，胆管狭窄4例。无死亡病例。结论LC是治疗胆囊疾病的最佳选择，但操作技术仍然较复杂，胆总管损伤的发生率较高。细致地操作及配合手术中胆道造影可以减少胆管损伤的发生。

Clinical Analysis of 1 787 Cases Receiving Laparoscopic Cholecystectomy

Objective To investigate the appropriate adaptation for laparoscopic cholecystectomy(LC) and the prevention and treatment of its complications.Methods The clinical data of 1787 patients receiving LC from 1998 to 2005 were retrospectively analyzed to determine the types of primary diseases,intraoperative complications and late-stage complications.Results The most frequent primary disease for LC was gallstone with chronic cholecystitis(81.02 %).Of all the patients,86 were with acute cholecystitis accompanied by gallstone(4.81%).The rate of conversion to laparotomy was 0.67%.Bile duct injury happened in 2 patients(0.11%).Bile leakage was found in 2 patients(0.11%).Late-stage complications included residual stone in common bile duct(6 cases) and bile duct stricture(4 cases).The mortality for the 1787 patients was 0.Conclusion LC is suitable for most gallbladder diseases.However,its procedure is still complicated and occurring rate of the complication of bile duct injury is high.Favorable results seem to depend on multiple training of LC procedure and intraoperative cholangiography.