基层医院腹腔镜胆囊切除术并发症特点及处理

Characteristics and treatments for complications of laparoscopic cholecystectomy in primary hospitals

目的探讨基层医院腹腔镜胆囊切除术(LC)手术并发症特点及处理。方法回顾性分析2015年1月至2019年12月在同济大学附属第十人民医院崇明分院行LC并发生手术并发症的11例患者临床资料。其中男4例,女7例;平均年龄(68±6)岁。原发病:急性胆囊炎6例,萎缩性胆囊炎2例,慢性胆囊炎3例。患者均签署知情同意书,符合医学伦理学规定。观察LC手术并发症发生情况,总结其处理及预防措施。结果本组同期LC术443例,手术并发症发生率2.5%(11/443),其中术中出血3例,1例中转开腹压迫止血,2例再行腹腔镜电凝止血;胆总管损伤2例,行开腹修补并T管引流;胆漏4例,予抗感染及生长抑素治疗;结肠肝曲损伤、十二指肠损伤各1例,予中转开腹修补并置管冲洗、引流。并发症发生病因明确7例,其中与胆囊炎症严重相关者3例,萎缩性胆囊炎相关者2例,医源性者2例;原因不明者4例。所有患者均治愈顺利出院,治愈率100%。结论基层医院LC手术并发症仍较高,多为高龄患者,并发症发生与胆囊炎症密切相关。选择适当病例,术前充分准备,术中仔细解剖,必要时及时开腹,有利于预防手术并发症发生。

Objective To investigate the characteristics and treatments for complications of laparoscopic cholecystectomy(LC)in primary hospitals.Methods Clinical data of 11 patients with complications following LC from January 2015 to December 2019 in Chongming Branch of Tenth People's Hospital of Tongji University were retrospectively analyzed.Among them,4 patients were male and 7 female,aged(68±6)years on average.The primary diseases were acute cholecystitis(n=6),atrophic cholecystitis(n=2)and chronic cholecystitis(n=3).The informed consents of all patients were obtained and the local ethical committee approval was received.The incidence of complications following LC was observed.The managements and prophylactics were summarized.Results 443 patients underwent LC at the same period,the incidence of LC complications was 2.5%(11/443).3 cases developed intraoperative bleeding,including 1 case was converted to open surgery for compression hemostasis,2 cases received laparoscopic electric coagulation for hemostasis again.2 cases suffered from common bile duct injury and underwent open surgery for repair and T-tube drainage.4 cases suffered from bile leakage and were given with treatments of antiinfection and somatostatin.1 case suffered from injury of hepatic flexure of the colon and 1 case of duodenal injury,and both were converted to open surgery for repair and drainage.The etiology of complications was confirmed in 7 cases,including 3 cases due to severe gallbladder inflammation,2 cases due to atrophic cholecystitis and 2 cases due to iatrogenic causes.While the causes of complications in 4 cases were unknown.All patients were cured and discharged with a healing rate of 100%.Conclusions The incidence of LC complications in primary hospitals is still high,which mostly occurs in elderly patients.The incidence of complications is closely related to cholecystitis.Selecting suitable cases,adequate preoperative preparation,careful anatomical dissection during LC,and timely conversion to open surgery when necessary contribute to the prevention of surgical complications.