腹腔镜胆囊切除术胆囊动脉出血的预防及处理

Prevention and treatment of bleeding of cystic artery during laparoscopic cholecystectomy

目的探讨腹腔镜胆囊切除术（LC）胆囊动脉出血的原因及防治方法。方法回顾性分析29例腹腔镜胆囊切除术中发生胆囊动脉出血原因、处理方法及效果。结果本组29例患者中,27例术中钛夹夹闭止血,2例中转开腹。处理时间约2~38min,平均20min。术后未发生继发出血及膈下感染,无胆管损伤,均痊愈出院。结论胆囊动脉变异和解剖Calot三角方法不当或三角处粘连重,分离困难层次不清是造成LC胆囊动脉出血的主要原因。分清胆囊动脉的走行,熟知异常胆囊动脉,轻柔解剖Calot三角是预防胆囊动脉损伤出血的关键。

Objective To evaluate laparoscopic cholecystectomy（LC） causes of cystic artery bleeding and prevention methods.Methods A retrospective analysis of the causes of bleeding cystic artery occurred,treatment methods and results of 29 cases of laparoscopic cholecystectomy.Results In 29 patients,27 patients with intraoperative bleeding titanium clip occlusion,2 cases were converted to laparotomy.Processing time is about 2~38min,an average of 20min.Postoperative did not occur secondary bleeding and subphrenic infection,bile duct injury,all patients were cured.Conclusions The cystic artery and anatomical variation of improper or triangle Calot triangle at the adhesion weight,difficult and poorly isolated cystic artery bleeding is caused by the main LC.To distinguish between cystic artery location,known cystic artery abnormalities soft anatomy of Calot triangle is the key to prevent bleeding cystic artery injury.