腹腔镜胆道手术后迟发性出血的防治

Prevention and treatment of delayed bleeding after laparoscopic biliary tract operation

目的探讨腹腔镜胆道手术后迟发性出血的原因及防治要点。方法对2002年2月～2006年10月施行了腹腔镜胆道手术的2875例患者的资料进行了回顾性分析。结果该组有9例(0.3%)术后发生迟发性出血,包括穿刺孔出血渗入腹腔2例;胆囊床出血2例;胆囊动脉分支出血1例;胆囊周围粘连组织出血1例;胆总管壁滋养血管出血1例;原发性纤溶亢进至创面渗血不止2例。结论腹腔镜胆道手术后迟发性出血具有隐蔽性并可能导致严重后果,应引起临床医生的足够重视。

[Objective] To study the cause and treatment of delayed bleeding after laparoscopic biliary tract operation. [Methods] The data of 2 875 patients who underwent laparoscopic biliary tract operation from February 2002 to October 2006 was reviewed. [Results] Delayed bleeding occurred in 9 of all patients, intraabdominal stagnant blood resulted from incision bleeding in 2 cases, gallbladder bed bleeding in 2 patients, cystic artery branches bleeding in I patient, adhesion tissues around gallbladder bleeding in I case, common bile duct nourish vessel bleeding in 1 patient, primary fibrinolysis experienced surface of wound bleeding in 2 patients. [Conclusions] Delayed bleeding may result in serious postoperative complications after laparoseopic biliary tract operation, so clinical physicians should pay high attention on it.