腹腔镜胆囊切除术严重并发症的原因及预防

CAUSES OF AND PREVENTION AGAINST SEVERE COMPLTCATIONS OF LAPAROSCOPIC CHOLECYSTECTOMY

目的分析腹腔镜胆囊切除术严重并发症的原因及预防措施。方法回顾性分析３５７６例腹腔镜胆囊切除术出现的３４例严重并发症的原因、处理及预后情况。结果３４例严重并发症中，胆管损伤１０例、胆瘘６例、胆总管残留结石７例、腹腔严重感染５例、急性胰腺炎３例、肠管损伤３例。１１例中转开腹，１９例术后再次剖腹处理，死亡４例。结论腹腔镜胆囊切除术引起的严重并发症，应使腔镜医师高度重视。

Objective To investigate the causes of severe complications of laparoscopic cholecystectomy (LC) and discuss the preventive measures for them.Methods Thirty-four cases of severe complication were reviewed out of 3576 cases of LC.Retrospective analysis was made on their causes,management and prognosis.Results It was found that the 34 cases included 10 cases of injury of the bile duct, 6 bile fistula, 7 residual stones in common bile duct, 5 celeic infection, 3 acute pancreatitis and 3 intestinal injuries. LC was shifted to laparotomy on table in 11 cases and celiotomy was performed after LC as the second surgery in 19 cases. The other 4 cases in the series resulted in death.Conclusion The doctor who performs LC should be fully aware of and prepared for the danger of severe complications of the procedure.