腹腔镜胆总管切开取石术的并发症及防治

Prevention and treatment of the complications in laparoscopic bile duct exploration and extraction of bile duct stones

目的 :探讨电视腹腔镜胆总管切开纤维胆道镜取石T形管引流术 (LCHTD)的并发症及防治措施。方法 :回顾分析LCHTD186例的临床资料。 186例中 15 0例行胆囊切除加胆总管切开术取石 ,36例单纯行胆总管切开术取石。结果 :186例中成功 183例 ,3例中转开腹 ,术中及术后 11例发生并发症 ,其中术中出血 2例 ,术后胆道出血 1例 ,胆管残留结石 3例 ,胆漏 2例 ,腹腔残石致腹腔感染 1例 ,T形管早期脱落 1例 ,胆囊管钛夹脱落于T形管窦道壁内 1例。患者均获治愈 ,无死亡病例。结论 :对电视腹腔镜胆总管切开纤维胆道镜取石T形管引流术的并发症应予以重视 ,掌握适应证 ,提高操作熟练程度 ,及时发现并采取积极治疗措施 。

Objective:To discuss the prevention and treatment of complications in laparoscopic choledochofiberscopic hepatocholangiolithotomy T-tube drainage (LCHTD).Methods:186 cases with LCHTD were retrospectively analyzed. Among them, 150 patients underwent LC and LCHTD,36 patients underwent LCHTD simply. Results:183 out of 186 patients obtained successful result, 3 patients were turned to open laparotomy. 11 cases had complications, of them, 2 cases had hemorrhage in operation,one case had bleeding in bile duct postoperative, 3 cases had postcholelithotomive residual gallstones, 2 cases had bililary fistula, one case had residual gallstones and infection in pertioneal cavity, one case had T-tube escaped from common bile duct early and one case had titanium clip dropped into T-tube sinus. All of them were cured with turning to laparotomy and postoperative surgical treatment respectively. Conclusions:The complications of LCHTD should be attached importance by laparoscopic surgeons. If occuring, proper and appropriate treatments should be adopted.