单中心腹腔镜胆囊切除术13000例的中转原因及主要并发症

Laparoscopic cholecystectomy:causes of conversion and major complications in 13 000 cases

目的探讨腹腔镜胆囊切除术(LC)严重并发症的原因及预防措施。方法回顾分析1991年9月至2004年8月13000例 LC 临床资料。结果13000例 LC 中转416例,中转率3.2%,发生并发症127例(0.98%),其中腹腔内出血21例,胆管损伤11例.胃肠道损伤7例.胆漏26例.遗漏腹腔内病变9例,胆管残留结石47例,腹腔感染4例,上消化道出血2例。结论术前注意鉴别诊断.术中轻柔操作,辨明胆囊三角区结构,必要时借助腹腔镜术中超声等检查是避免 LC 严重并发症的有效方法。

Objective To investigate the reasons for open conversion and the prophylactic meas ures for serious complications of laparoscopic cholecystectomy （LC）. Methods The clinical data of 13000 patients receiving LC in our hospital from 1991 to 2004 were retrospectively analyzed to determine the reasons for open conversion and operative complications. Results The overall conversion rate was 3.2% （416 patients）. The occurring rate of operative complications was 0. 98% （127 patients）. The operative complications included abdominal cavity internal bleeding in 21 patients, bile duct injury in 11, gastrointestinal injury in 7, bile leakage in 26, missed malignant tumors in 9, missed bile duct stone in 47, abdominal cavity infection in 4 and upper digestive tract hemorrhage in 2. Conclusions The serious complications of LC can be avoided by paying close attention to distinguishing the atypical gallstone pain from the clinical symptoms of other gastrointestinal disorders, having tender operation and differing cyst duct from other structures in Calot＇s triangle or using laparoscopic ultrasonography if necessary.