腹腔镜联合胆道镜保胆取石术并发症的分析

Complications of laparoscopic combined with choledochoscopic gallbladder-preserving cholelithotomy

目的:探讨腹腔镜联合胆道镜保胆取石术的手术风险因素、并发症及相应防范措施。方法:回顾2012年10月至2014年10月腹腔镜联合胆道镜直视下成功施行259例保胆取石术的临床资料,分析手术风险、术后并发症的发生原因、伴随症状及具体防治措施。结果:259例患者中2例术中损伤胆囊,致胆囊穿孔,4例切口愈合不良,3例肋缘下切口疼痛,5例胆囊结石复发,无胆漏、血管损伤、结石残留及死亡病例。结论:把握手术适应证,精细操作,术中保护切口防止胆汁污染等是控制手术并发症发生的重要措施。严格掌握手术指征,手术操作技术规范、熟练,围手术期及时细致的处理是安全、有效开展保胆取石术的关键因素。

Objective： To discuss the risk factors and complications of laparoscopic combined with choledochoscopic gallbladder-preserving cholelithotomy and explore the precautionary measures of complications. Methods： The clinical data of 259 patients who underwent laparoscopic combined with choledochoscopic gallbladder-preserving cholelithotomy between Oct. 2012 and Oct. 2014 were reviewed in order to analyze the surgical risk,reasons of postoperative complication,accompanying symptoms and specific precautionary measures. Results： Two of 259 patients suffered from injury of gallbladder,which resulted in gallbladder perforation,4 patients experienced poor healing of incision,3 cases of costal margin incision pain occurred,gallstone recurrence was found in 5 patients. No complications such as vascular injury,bile leakage,residual calculi or death occurred. Conclusions： The critical steps to reduce complications are in strict accordance with operative indication,accurate operation,intraoperative protection incision to avoid bile contaminate. The key factors to ensure secure and valid developing gallbladder-preserving cholelithotomy are in strict accordance with operative indication,standardized and skilled operation,meticulous and timely disposition in the perioperative period.