腹腔镜胆囊切除术后膈下胆囊床积液的防治

Prevention and treatment of post-LC subphrenic and hepatic-bed accumulation of fluid

目的探讨腹腔镜胆囊切除术(LC)后膈下、胆囊床积液的防治。方法回顾分析1 500例LC术后并发膈下、胆囊床积液患者20例。其中胆囊床积液16例(1例为胆漏合并出血),膈下积液4例(其中感染2例)。3例保守治疗,2例腹腔镜再次引流,B超引导穿刺抽吸14例,开腹引流1例。结果20例患者均治愈,住院时间平均2周。结论术中适度分离粘连,减少渗出,合理放置引流,术后仔细观察,及时发现,及时处理,效果满意。

Objective To discuss the prevention and treatment of post-LC subphrenic and hepatic-bed accumulation of fluid. Methods Twenty cases of post - LC hydrops from October 1996 to December 2003 were retrospectively analyzed. Among them, there were 16 cases of hepatic - bed accumulation of fluid （one case of bile leakage associated with secondary bleeding） and 4 cases of subphrenic accumulations of fluid （2 cases of abscesses）. Three cases were subjected to conservative treatment, 2 to secondary laparoscopic drainage, one to open drainage and the remaining 14 to simple acupuncture suction under BUS. Results Twenty cases all were cured. The average hospital stay was 2 weeks. Conclusion Proper dissection and drainage is important for decreasing complications. Careful post - operative observation must be kept in mind, so as to immediately discover the complications and treat with various methods.