腹腔镜胆囊切除术后近期再手术的原因及处理

The reasons and disposal of reoperation after laparoscopic cholecystectomy in a short period

目的 :探讨腹腔镜胆囊切除术 (LC)后近期再手术的原因及治疗。方法 :对我院 1991年 3月～ 2 0 0 1年 6月 936 9例LC术后近期再手术 2 6例 (占 0 .2 8% )病人的临床资料作分析讨论。结果 :再手术中 ,胆总管损伤 7例 ,肝总管损伤 1例 ,右肝管损伤 1例 ,胆囊管残端漏 4例 ,十二指肠损伤 1例 ,血管损伤致腹腔出血 2例 ,胃癌 1例 ,胆总管囊肿 1例 ,胆总管残余结石 6例 ,术后腹腔积液并发热 2例。全组病人均经手术治疗痊愈。结论 :在LC的诊治过程中 ,注意严格的术前检查和规范的手术程序可大大减少腹腔镜胆囊切除术的再手术率。

Objective:To explore the reasons and disposal of reoperation after LC in a short period.Methods:To analyse and discuss the clinic data of 26(0.28%) patients who had been reoperated from 9369 LC cases form March of 1991 to June of 2001.Results:Reasons of reoperation:seven cases injured in choledocho,one case in common hepatic duct and one case in right hepatic duct,four cases leaking in stump of cystic duct,one case injured in dodecadactylon,one case bleeding in abdominal cavity due to injury of blood vessel,one case suffering from carcinoma of stomach and one case from choledochal cyst,six cases leaving over concretion of choledocho and two cases accumulating fluid of abdominal cavity with febrile. All cases were recovered after operation.Conclusion:In order to reduce the rate of reoperation,it is important to check strictly before operation and specify the procedures of surgery during the process of LC.