腹腔镜胆囊切除术后再手术的临床体会(附30例报告)

Clinical experience of reoperation after laparoscopic cholecystectomy:with a report of 30 cases

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)术后因各种并发症而再次行开腹手术或腹腔镜手术的原因、诊断方法、手术方式及预后。方法:回顾分析1994年6月至2011年12月30例LC术后再次手术患者的临床资料。结果:30例再次手术的患者中,肝外胆管损伤5例,胆漏15例,腹腔出血6例,内脏损伤2例,胆绞痛2例,均于LC术后再次行开腹或腹腔镜手术治愈,无死亡病例。术后随访3～10年,无并发症发生。结论:术前熟练掌握胆道系统的解剖关系、严格把握手术适应证,术中精细解剖、分离,科学判断,可降低LC术后并发症发生率及再手术率。

Objective：To investigate the causes, diagnostic methods, operation modes and prognosis of reoperation caused by various complications after laparoscopic cholecystectomy （LC）. Methods ： A retrospective analysis was made on the clinical data of the 30 reoperation patients after LC in 5 660 patients from Jun. 1994 to Dec. 2011. Results：In 30 cases of reoperation patients, extrahepatic biliary tract injury was found in 5 cases, biliary fistula was found in 15 cases, abdominal hemorrhage occurred in 6 patients, visceral injury occurred in 2 cases, and biliary colic occurred in 2 cases. All cases were discharged after the second operation through either open or laparoscopic surgery. No death occurred. During the postoperative follow-up of 3 to 10 years, no complications were found. Conclusions ： It may reduce the rate of complications and reoperation after LC by proficient mastering the anatomic relationship between the biliary system, strict grasping the operation indications, meticulous conducting anatomical separation during operation, and having scientific judgment to active prevention.