腹腔镜胆囊切除术后黄疸的分析及处理

Jaundice following laparoscopic cholecystectomy: Etiology and management

目的 探讨腹腔镜胆囊切除术 (LC)后黄疸的原因及治疗方法。 方法 回顾性分析 1 995年 1 0月～ 2 0 0 1年 1 2月施行LC术 2 0 4 7例中 1 1例术后黄疸的原因及处理。 结果 本组术后黄疸的发生率为 0 5 4 % (1 1 / 2 0 4 7) ,原因为胆漏 (5 /1 1 ,4 5 4 % )、胆总管结石残留 (2 / 1 1 ,1 8 2 % )、急性胰腺炎 (2 / 1 1 ,1 8 2 % )、胆管炎性狭窄 (1 / 1 1 ,9 1 % )及急性肝功能损害 (1 / 1 1 ,9 1 % )。分别采用内镜下手术、开腹手术和保守治疗 ,取得满意疗效。 结论 LC术后黄疸原因以胆漏及胆总管结石残留最为常见 。

Objective To investigate causes and the treatment of jaundice following laparoscopic cholecystectomy (LC). Methods A retrospective analysis of records of 11 cases of jaundice following LC out of 2047 cases between October 1995 and December 2001 was made. Results The incidence of postoperative jaundice was 0.54% (11 of 2047). Jaundice was due to bile leakage (45.4%, 5 of 11), residual choledocholithiasis (18.2%, 2 of 11), acute pancreatitis (18.2%, 2 of 11), biliary stricture (9.1%, 1 of 11) and acute liver infraction (9.1%, 1 of 11). Three kinds of procedures-endoscopic operation, open operation and conservative treatment-were executed respectively and had obtained satisfactory results. Conclusions Bile leakage and residual choledocholithiasis were the leading causes of jaundice following LC. Prompt etiologic therapy may effectively relieve the symptoms.