胆囊微小结石行腹腔镜手术的危险性及应对策略

Risk and Therapy Strategy of Tiny Gallbladder Stones During Laparoscopic Cholecystectomy

目的探讨胆囊微小结石患者行腹腔镜胆囊切除术(LC)的危险性及其应对处理办法。方法回顾性分析我院2013年9月至2014年7月期间收治的932例胆囊微小结石行LC患者的临床和随访资料。结果所有患者均顺利完成LC,无一例中转开腹。有2例(0.21%)患者术后并发胆总管结石。有86例(9.23%)患者术中发生胆囊破裂,其中有26例术后2个月出现右上腹隐痛,复诊腹腔残存小结石;有57例无不适症状,复诊腹腔残留结石消失;1例术后并发戳孔感染;2例并发腹腔小脓肿。未见并发急性胰腺炎和戳孔疝的病例。本组有51例术中胆囊破裂、2例腹腔脓肿、1例戳孔感染、1例胆总管结石的病例均为急性胆囊炎患者。结论对胆囊微小结石行LC易致胆总管结石,引起急性胰腺炎;若LC术中胆囊发生破裂,易致小结石残留于腹腔,从而导致腹腔感染、脓肿、切口感染和诱发切口疝,其在急性胆囊炎患者中发生率更高,因此针对性的手术处理可有效避免和减少其不良并发症的发生。

Objective To analyze risk and therapy strategy of tiny gallbladder stones during laparoscopic cholecystectomy（LC）. Method The clinical data of 932 patients with tiny gallbladder stones performed LC from September 2013 to July 2014 were analyzed retrospectively. Results The LC was successful in all the patients. The gallbladders were ruptured in 86（9.23%） patients during operation. Following up 1-3 months, there were 26 patients with right upper abdominal pain and with residual small stones in the abdominal cavity, 57 patients without uncomfortable symptoms and without residual gallstone, 2 cases complicated with lesser abdominal abscess, 1 case complicated with incision infection. The incisional hernia and acute pancreatitis were not found. Conclusions The gallbladder with full of tiny stones performed LC easily leads to choledocholithiasis or acute pancreatitis. If intraoperative gallbladder rupture, the tiny stones might be residual in the peritoneal cavity and lead to abdominal infection or abscess, and incision infection or trocar site hernia. Specific operation could effectively avoid adverse complications.