腹腔镜胆囊切除术中胆囊动脉出血的处理体会

Treatment experience of cystic artery bleeding during laparoscopic cholecystectomy

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)术中胆囊动脉损伤出血的原因及处理方法。方法:回顾分析2013年1月至2016年8月12例LC术中胆囊动脉损伤出血患者的临床资料。结果:12例均在腔镜下进行妥善止血处理,并完成LC,无中转开腹。手术时间30~150 min,平均(87.60±17.40)min;术中出血量30~150 ml,平均(63.10±11.20)ml;术后2~5 d出院,平均(5.10±0.67)d。术后患者均获随访,随访6~24个月,平均(18.4±2.1)个月,患者均恢复良好,无并发症发生。结论:LC术中引起胆囊动脉损伤出血的原因是多方面的,既有解剖因素,也有病理因素及术者操作技术因素等,而且有时是多种因素共同作用的结果。术中损伤胆囊动脉或其分支引起出血时,术者应沉着冷静,切忌在视野不清的情况下慌乱钳夹电凝止血,应根据术中血管损伤的具体情况、术者经验与操作技能,个体化地进行止血处理。

Objective：To investigate the cause and treatment of cystic artery bleeding during laparoscopic cholecystectomy （LC）.Methods：Clinical parameters of 12 cases of cystic artery bleeding during LC from Jan.2013 to Aug.2016 were retrospectively analyzed.Results：All cases successfully underwent laparoscopic hemostatic treatment and LC,none was converted to laparotomy.The average operation time was （87.60±17.40） min （range,30-150 min）,and intraoperative blood loss was （63.10±11.20） ml （range,30-150 ml）.Postoperative hospital stay was （5.10±0.67） d （range,2-5 d）.All patients were followed up for （18.4±2.1） months after operation （range,6-24 months）,and recovered well with no complications occurred.Conclusions：The causes of cystic artery bleeding during LC are various,including the factor of anatomy,pathology,operation technique and so on.Sometime,the result is caused by multiple factors.Operators should be calm during handling cystic artery bleeding,choose the individualized hemostatic treatment according to the situation of vascular injury,the experience and technique of the operator,and avoid confused clamping and electrocoagulation for hemostasis in a blurred vision.