腹腔镜胆囊切除术并发症的防治

Prevention and treatment of complications of laparoscopic cholecystectomy

目的:探讨如何降低腹腔镜术后并发症,尤其是胆管损伤、胆漏及出血等。方法:对1786例腹腔镜胆囊切除术的资料进行回顾性分析。结果:46例中转开腹;18例出现了不同程度的并发症,其中胆漏5例、出血3例、胆管损伤2例、胆管残余结石4例、胰腺炎3例、切口疝1例,均经再次腹腔镜、开腹或保守治疗痊愈。本组无死亡。结论:术中正确识别与处理变异胆囊管和胆囊动脉,避免电灼损伤周围组织,冷静处理术中出血是减少胆管损伤、胆漏及出血的重要措施。再次腹腔镜手术处理腹腔镜胆囊切除术的并发症是可行的。

Objective：To investigate the prevention and treatmen of complications of laparoscopic cholecystectomy,especially bile duct injury,bile leakage,bleeding and so on.Methods：1786 patients undergoing laparoscopic cholecystectomy from October 1999 to January 2004 were analysed retrospectively.Results：Among 1786 cases of laparoscopic cholecystectomy,40 cases were convertted to laparotomy.There were 18 cases occurring different extent complications,including bile leakage in 5 cases,bleeding in 3,bile duct injury in 2,bile duct residual stones in 4,acute pancreatitis in 3 and incisional hernia in 1 case.All complications were cured by relaparoscopic operation and laparotomy or non-operation methods.Conclusion：Accurately identifying and managing abnormal cystic duct and cystic artery as well as electrical burn of surrounding tissue during operation are the important measure to reduce bile duct injury,bile leakage and bleeding.Relaparoscopic operation in the management of complications of laparoscopic cholecystectomy is safe and feasible,with good curative effects.