腹腔镜胆囊切除术中结石漏入腹腔的原因及处理

Reasons and treatment ways of gallstone leaking in peritoneal cavity during laparoscopic cholecystectomy

目的:探讨腹腔镜胆囊切除术(LC)中结石漏入腹腔发生的原因及预防。方法:回顾分析512例LC术中结石漏入腹腔发生的原因,探讨其预防措施及处理经验。结果:LC术中结石漏入腹腔32例,发生率为6.25%。LC术中结石漏入腹腔后多全部取出,腹腔残留结石患者无腹腔脓肿及窦道形成等并发症出现。结论:预防腹腔漏入结石的关键是LC术中防止胆囊分破或取出时撕破致胆汁、结石漏入腹腔,胆囊分破、结石落入腹腔后采取必要的处理措施,LC术中结石落入腹腔未能全部取出,可严密随访,不必为此中转开腹。

Objective：To investigate the reasons and treatment ways of gallstone leaking in peritoneal cavity during laparoscopic cholecycstectomy （LC）. Methods：512 patients with gallstone spillage into peritoneal cavity during LC were analysed retrospectively, and the successful experiences were summed up. Results：There were 32 patients with gallstone spillage during LC and the incidence of gallstone spillage was about 6.25%. There were not complications caused by these spilled stones,such as peritoneal abscess, stone migration through retroperitoneum to a previous surgical wound or mechanical small obstruction by a five years follow up. Conclusions： The key step to prevent concretions seeped into abdominal cavity is avoiding gallbladder teared, which leading bile and concretions seep into abdominal cavity. The emergency action to this condition must be taken. However, it is not recommended to perform laparotomy in order to remove all spillage gallstones during LC because most retained stones are harmless to patients.