腹腔镜胆囊切除术后近期再手术的原因及对策(附19例报告)

The reasons and strategies of reoperation in the near future after laparoscopic cholecystectomy:with a report of 19 cases

目的:探讨腹腔镜胆囊切除术(LC)后近期再手术的原因、手术方式及预防措施。方法:分析1995年至2004年6 016例LC术后再手术的19例患者的临床资料。结果:再手术的原因为胆总管损伤2例、腹腔内出血8例、胆总管残余结石7例、胆囊管残端漏2例。再手术方式分别为胆总管端端吻合术、胆总管空肠Roux-en-Y吻合术、剖腹止血术、EST、胆总管切开取石术。19例均经手术治愈,未出现严重并发症。结论:减少LC术后再手术的关键是掌握好LC的适应证,术中精细操作,适时中转开腹,合理放置引流管。

Objectlve：To explore the reasons, operation-styles and preventive measures of reoperation in the near future after LC. Methods：The clinic data of 19 patients who had been reoperated in 6016 cases of LC from 1995 to 2004 were analyzed. Results： Reasons of reoperation were as follows：2 cases were injured in common bile duct; 8 cases were intraperitaneal hemorrhage; 7 cases were retained calculus in common bile duct; 2 cases were cystic duct fistula. The reoperation-styles were as follows： choledochocholedo- chostomy, Roux-en-Y choledochojejunostomy,laparotomy of hematischesis,EST, choledocholithotomy. 19 cases were all cured by operations without severe complication. Conclusions： The keys to reduce the rate of reoperation are controlling the indication of LC, operating carefully,using laparotomy when necessary and placing the drain rationally.