腹腔镜胆囊切除术后黄疸的原因及对策

The reasons and countermeasures of jaundice after laparoscopic cholecystectomy

目的 :探讨腹腔镜胆囊切除术 (LC)术后黄疸的原因、预防措施及处理方法。方法 :回顾分析12 5 6 0例LC术后发生黄疸的 2 3例 (0 18% )临床资料。结果 :本组术后 2 3例黄疸中胆管损伤 9例 ,胆道结石6例 ,急性肝炎 2例 ,胆源性胰腺炎 2例 ,溶血性疾病 1例 ,肝癌 1例 ,药物性黄疸 2例。除 1例死于肝癌外 ,余均痊愈 ,其中 13例非手术治愈 ,9例手术治疗痊愈。结论 :LC后黄疸原因复杂 ,胆管损伤和胆道结石是其主要原因 ;在诊治LC的过程中术前严格检查 ,手术程序规范 ,可减少LC后黄疸发生率。

Objective:To investigate the reasons,preventive measures and treatment of jaundice after laparoscopic cholecystectomy.Methods:The reasons of 23 cases(0.18%)of jaundice were retrospectively analysed in 12 560 cases laparoscopic cholecystectomy.Results:In this group,there were 9 cases of damages in choledoch,6 cases of choledocholith,2 cases of acute hepatitis,2 cases of gallstone pancreatitis,1 case of hemolytic jaundice,1 case of liver cancer and 2 cases of drug-induced jaundice.22 cases were cured, 1 case died from liver cancer,13 cases were healed without operation,9 cases were cured by operation.Conclusions:The causes are complicated.Injured in choledoch and leaving out concretion of choledoch are the main reasons of jaundice in laparoscopic cholecystectomy.In order to reduce rate of jaundice,it is important to check strictly before operation and specify the procedure of surgery during the process of laparoscopic cholecystectomy.