腹腔镜胆囊切除术中出血的原因及防治

Causes, Prevention and Treatment of Bleeding During Laparoscopic Cholecystectomy

【目的】探讨腹腔镜胆囊切除术（LC）术中各种出血的原因及处理对策。【方法】回顾性分析64例腹腔镜胆囊切除术中发生出血的原因、处理方法及效果。【结果】术中因处理胆囊动脉失误而出血21例（32．81％），因损伤胆囊床而出血27例（45．31％），因损伤肝右动脉及其分支而出血2例（3．23％），因损伤门静脉右前分支而出血2例（3．23％），前哨淋巴结出血7例（10．94％），网膜血管出血2例（3．23％），切口出血3例（4．69％）。钛夹钳夹止血29例（45．31％），电凝止血17例（26．56％），腔镜下缝扎止血7例（i0．93％），开腹止血11例（17．19％），均痊愈出院。【结论】LC术中发生出血的原因很多，清晰解剖动脉主干和分支方可预防胆囊动脉出血。胆囊床出血的预防在于操作轻柔并按解剖层次剥离胆囊。

[Objective]To explore the causes and treatment methods of bleeding during laparoscopic cholecystectomy（LC）. [Methods] The causes, treatment methods and results of 64 cases with bleeding during LC were analyzed retrospectively. [Results] There were 21 cases of bleeding（32.81%） caused by the fault of treating the cholecystic artery, 27 cases （45.31%） caused by the fault of treating gallbladder bed and 2 cases （3.23%） caused by the injury of right hepatic arteria and its branches, 2 cases （3.23%） caused by the injury of anterior division of portal vein, 7 cases of sentinel node bleeding （10.94 %）, 2 cases of retina angiorhagia （3.23%） and 3 cases of incision bleeding（4.69%）. There are 29 cases of bleeding（45.31%） stopped by using titanium tongs, 17 cases（26.56 % ） stopped by electric coagulation, 7 cases （ 10. 93 % ） stopped by transfixion under endoscope and 11 cases（17.19 %） stopped by laparotomy. All patients were cured and discharged from the hospital. [Conclusion] Bleeding during LC can be caused by many reasons. Artery trunk and branches should be dissected clearly in order to avoid the bleeding of eholecystic artery. The gallbladder should be dissected slightly and softly according to anatomical structure in order to avoid the bleeding of gallbladder bed.