腹腔镜胆囊切除术后黄疸的诊治体会

Diagnosis Experience of After Laparoscopic Cholecystectomy Method Jaundice

目的探讨腹腔镜胆囊切除(LC)后黄疸的原因、预防措施及处理方法。方法回顾分析性本院4362例LC后发生黄疸的36例临床资料并结合文献进行总结。结果内科性黄疸16例,梗阻性黄疸20例(包括胆道损伤7例,胆总管结石9例,胆道蛔虫2例,原因不明2例)。开腹手术中1例患者继发腹腔脓肿转上级医院治疗,其余治愈。结论 LC后黄疸与许多因素有关,十分复杂,我们必须详细全面的检查以明确诊断,区分梗阻性黄疸与内科性黄疸。梗阻性黄疸以胆管损伤和胆道结石为主要原因,内科性黄疸与术前患者的肝功能状况、中气腹压力大小、手术时间长短密切相关,当诊断不明确时,处理应更为谨慎,强调对发生黄疸病例的处理采用个体化原则。

Objective To summarize the reasons and treatments of jaundice after LC. Methods After review analytical this courtyard 4362 example LC has the jaundice 36 example clinical material and unifies the literature to carry on the summary. Results The internal medicine department jaundice 16 examples, the obstruction jaundice 20 examples （damage 7 examples including biliary duct, choledoch stone 9 examples, biliary duct roundworm 2 examples, reason unclear 2 examples）.In 36 examples opens abdomen surgery 1 to continue sends the abdominal cavity abscess to transfer the higher authority hospital treatment, other cure. Conclusion After LC jaundice associated with many factors, very complex, we have a detailed and comprehensive checks to a definitive diagnosis, the distinction between obstructive jaundice and jaundice of internal medicine. Obstructive jaundice and biliary calculus of bile duct injury as the main reason, internal preoperative liver function status in patients with jaundice, pneumoperitoneal pressure closely related to size, length of operation, when the diagnosis is not clear, its treatment should be more cautious, emphasizing the principles of handling individual cases of jaundice occurs.