腹腔镜下胆囊切除术并发出血临床观察及预防措施

Clinical observation and preventative measures of laparoscopic cholecystectomy complicated by bleeding

目的分析腹腔镜胆囊切除术并发出血的特点,探讨有效的预防措施。方法选取158例腹腔镜下胆囊切除术患者作为观察组,其中30例并发出血,观察30例患者的出血情况,同时采用相应的方法止血,总结探讨出血的预防措施。选取同期行开腹胆囊切除术的患者100例作为对照组,比较两组患者手术情况、术后并发症发生情况及住院时间。结果 158例观察组患者中,30例并发出血,对照组20例并发出血。观察组出血患者经电凝以钛夹钳夹,电凝并填塞止血材料,压迫缝合止血等止血措施后,均成功止血。观察组患者术中出血量为(68.5±15.6)mL,住院时间为(5.2±2.3)d,切口感染率为5.06%,对照组分别为(85.6±18.2)mL、(7.5±2.1)d、14.00%,两组比较,差异均有统计学意义(均P<0.05)。结论腹腔镜下胆囊切除术相比传统开腹手术而言,创伤小,术后恢复快。但术中易并发出血,术者应根据出血情况给予不同的方法止血。

Objective To analyze the characteristics of laparoscopic cholecystectomy complicated by bleeding and explore effective preventive measures.Methods 158 patients undergoing LC（observation group） were selected,of whom 30 patients were complicated by bleeding.Bleeding conditions of the 30 patients were observed.Meanwhile,relevant hemostasis methods were used and preventative hemostatic measures were summarized.100 patients receiving LC in the corresponding period were selected as the control group.Then the operative conditions,postoperative complications and length of hospital stay of the two groups were compared.Results 30 out of 158 patients of the observation group were complicated by bleeding and 20 patients in the control group were complicated by bleeding,After electrocoagulation titanium clip clamping,electrocoagulation and hemostatic materials stuffing,oppression and suturing and other hemostatic measures,all the hemostasis was successful in the observation group.In the observation group,the intraoperative blood loss was（68.5±15.6）mL,the length of hospital stay was（5.2±2.3） days and the incision infection rate was 5.06%,and in the control group,those were（85.6±18.2）mL,（7.5±2.1） days and 14.00%,with statistically significant differences between the two groups（all P 0.05）.Conclusion Compared with traditional open surgery,laparoscopic cholecystectomy has the characteristics of small trauma and fast recovery,but may be predisposed to intraoperative bleeding,the surgeons should prevent the bleeding using different methods.