腹腔镜胆囊切除术并发症的处理(附15例报告)

Complications of laparoscopic cholecystectomy:a clinical analysis of 15 cases

目的:分析总结腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)并发症的发生原因及处理方法。方法:选取2016年2月至2017年2月15例LC术后发生并发症的患者,回顾分析其临床资料,总结并发症发生原因、预防及处理措施。结果:本组15例均顺利完成手术,手术时间平均(46.5±7.2)min,平均住院(7.6±2.1)d。并发症包括胆漏3例(20.0%),腹腔出血4例(26.67%),胃肠道损伤3例(20.0%),胆管损伤2例(13.33%),胆道结石残留2例(13.33%),腹腔积液1例(6.67%)。经对症处理后患者均好转出院。结论:胆管损伤、胆漏、腹腔出血、胃肠道损伤、胆道结石残留及腹腔积液等均是LC术后常见并发症,术前应严格掌握手术指征,术中规范手术操作、准确判断与识别,并及时中转开腹,以有效保障手术质量及患者安全、降低并发症发生风险。

Objective： To analyze and summarize the causes and treatment of complications in laparoscopic cholecystectomy（ LC）. Methods： Fifteen patients with complications of LC from Feb. 2016 to Feb. 2017 were selected and their clinical data were retrospectively analyzed in order to summarize the causes of complications and to explore effective prevention and treatment measures. Results： All the 15 patients were operated successfully. The operation time was（ 46. 5 ± 7. 2） min,and the hospitalization time was（ 7. 6± 2. 1） d. There were 3 cases of bile leakage（ 20%）,4 cases of abdominal hemorrhage（ 26. 67%）,3 cases of gastrointestinal injury（ 20%）,2 cases of bile duct injury（ 13. 33%）,2 cases of residual biliary stones（ 13. 33%）,and 1 case of ascites（ 6. 67%）. After symptomatic treatment,all patients were discharged from hospital. Conclusions： Bile duct injury,bile leakage,abdominal bleeding,gastrointestinal injury,bile duct residual calculi and peritoneal effusions are common complications of LC. To effectively ensure the quality of operation and safety of patients and reduce the risk of complications,surgical indications should be strictly controlled,meanwhile standardized operation,accurate judgment and recognition in the operation,and timely conversion to laparotomy are also essential.