腹腔镜胆囊切除术后再次手术18例临床分析

Re-operation after laparoscopic cholecystectomy,analysis of 18 cases

目的探讨腹腔镜胆囊切除术（ＬＣ）后再次手术的原因、手术方式及其预防措施。方法对１８例ＬＣ后再手术患者的诊治进行回顾性分析。结果再手术率０．８４％，再手术的原因为胆道损伤３例、胆漏５例、胆总管残留结石６例、腹壁戳孔癌种植转移２例、胆囊管残端炎２例。１７例经再手术治愈，１例因胆囊癌广泛转移死亡。结论降低ＬＣ后再手术率的关键在于掌握好ＬＣ的适应证，术中正确的手术操作以减少并发症的发生，及对并发症的正确处理。

Objective To discuss on the cause of re-operation after laparoscopy cholecystectomy(LC) and the operative and preventive measures. Methods In our hospital it has conducted 1 780 cases of LC operation during May, 1992 to May, 2001, among which 15 have been re-operated. 447 out of 1 780 cases of LC operation were performed during May, 1992 to Dec, 1995 and 10 of them were re-operated. 1 333 out of 1 780 cases of LC operation were performed during January, 1996 to May, 2001 and 5 of them were re-operated. During this period another 3 cases of re-operation after LC operation were transferred from other hospitals. Our team performed all together 18 cases of re-operations after LC operation. Of the 18 cases, 6 are male and 12 female, aging from 22～78, with average age being 52.2. Clinic analysis of re-operation on these 18 cases was conducted. Results The re-operation rate is 0.84% among them there were due to biliary passage injury 3 cases, biliary fistula 5 cases , residual gallstone in common bileduct 6 cases, metastatic cancer implanted on from perforated abdominal wall 2 cases and symptomatic inflammatory cystic duct stump 2 cases.All cases of re-operations recovered but 1 died from widespread metastasia of gallbladder carcinoma. ConclusionMany causes of re-operation are related with LC complications and most of them are discovered during operation. A small number of complications are quite dormant that are not discovered during operation and others are treated improperly,requiring the re-operation. Faults in selection indication and operative procedure are also the important causes of re-operation. In order to reduce the re-operation rate it suggests that the restrsted selection of indications and operative procedure , avoidance and proper management of complication,are the important principles should be followed.