腹腔镜胆囊切除术出血性并发症的原因及对策(附11例报告)

On causes and countermeasures of hemorrhagic complications of laparoscopic cholecystectomy: A report of 11 cases

目的总结腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）术中、术后出血的原因及预防和处理办法。方法分析2003年lO月～2005年6月我院2024例LC中11例术中、术后发生出血的临床资料。术中出血8例，2例中转开腹止血，余6例行钛夹、电凝、压迫、缝扎等止血；术后出血3例，腹腔镜探查止血。结果手术时间45～180min，平均65min。术后病理检查与术前诊断一致。所有出血均得到有效控制，治愈出院。术后住院时间3～10d，平均4，5d。11例随访1—12个月，平均3个月，均无再发出血。结论术中、术后出血是LC的主要并发症之一，严格掌握手术指征，熟练细致的操作，及时有效的处理可以避免出现严重后果。

Objective To summarize causes, prevention, and treatment of intra- or post-operative hemorrhagic complications of laparoscopic cholecystectomy. Methods Clinical data of 11 cases of intraor post-operative hemorrhagic complications out of 2 024 cases of laparoscopic cholecystectomy from October 2003 to June 2005 in this hospital were analyzed. Out of 8 cases of intraoperative hemorrhage, conversions to open surgery were required in 2 cases, and laparoscopic hemostatic performance with titanium clipping, electrocoagulation, pressure hemostasis, or suture ligation was used to stop the bleeding. Post-operative hemorrhage occurred in 3 cases and was cured with laparoscopic exploration. Results The operation time was 45 - 180 min （ mean, 65 min）. Postoperative pathological findings were in agreement with the pre-operative diagnosis. All the cases were cured and discharged from hospital. The post-operative hospital stay was 3 ~ 10 d （mean, 4.5 d）. Follow-up checkups in 11 cases for 1 ~ 12 months （mean, 3 months） showed no recurrence of hemorrhage. Conclusions Intra- or post-operative Hemorrhage is one of the major complications of laparoscopic cholecystectomy. It can be avoided by strict following the indications, skillful performance, and immediate and effective management.