腹腔镜胆囊切除术中转原因及其并发症防治(附5000例报告)

Cause of conversion to laparotomy and prevention of complication about 5000 cases laparoscopic cholecystectomy

目的探讨腹腔镜胆囊切除术中转原因和(LC)并发症的原因及预防措施。方法总结分析1997年5月至2007年5月5000例LC患者临床资料。结果5000例LC患者中转开腹247例,中转率4.94%,发生并发症31例,占0.6%,其中腹腔内出血16例,胆管损伤4例,手术胆漏6例,残留胆管结石2例,胆囊窝积液3例。结论术中仔细操作,炎症粘连重、解剖关系不清时不强行分离电凝电切,果断中转开腹是防治LC严重并发症的可靠保证。对微小结石病人,术晨询问夜间是否发生过胆绞痛;术晨常规B超了解胆管有无结石和扩张;术中勿反复牵拉挤压;在靠近胆囊侧先施小钛夹夹闭胆囊管再手术;胆囊管直径>1cm,应作术中造影和(或)术中B超是防止术后遗留胆总管结石的有力措施。预防性放置引流管是防止胆囊窝积液和感染的可靠保证。

Objective To study the causes of complication and the prevention methods about lapsroscopic cholecystectomy(LC). Methods Clinical data on 5000 patients underwent LC between May. 1997 and May. 2007 was analysed retrospectively. Results Totally 247 cases underwent conversion to Laparotomy,the rate of conversion was 4.94%. 31 cases have complications,occupied 0.6% of total amount,including: abdominal hemorrhage16cases,bile duct injury 4cases,bile leakage 6 cases,retained Bile-duct stones 2 cases,gallbladder fossa fluid 3 cases. Conclusion To prevent severe complication of LC,we should be carefull in operation;laparotomy when there is sereve adhesion and(or)unclear anatomy relationship;inquire patient with micro calculi whether biliary colic in night,know to whether biliany stones and biliany ract dilatation by B-ultrasound,don’t repeted extrusion;operate after to clip cystic duct by titanium clip at gallbladder side;take intraoperation cholangiopancreatography and (or) B-ultrasound when the diameter of cysticduct is more than 1 cm,were effectual methods to prevent retained bile duct stones. Preventing drainage tube will prevent gallbladder fossa fluid and infection.