腹腔镜胆囊切除手术并发症的预防.pdfVIP

中华临床医学杂志 ，2008年 l2月 。第9卷 ，第 l2期 论著 腹腔镜胆囊切除手术并发症的预防 梁 宏 【摘要】目的 减少腹腔镜胆囊切除的并发症。方法 回顾我院2004年4月～2008年 10月1697例腹腔镜胆 囊切除术资料。结果 我院1697例中最大年龄87岁，最小 14岁，平均年龄 5O．2岁。胆囊息肉214例，胆囊结石 1483例。胆囊结石病人中慢性结石性胆囊炎急性发作 354例。伴胆囊颈或胆囊管结石嵌顿49例。萎缩性胆囊炎 18例。中转开腹 62例，占2．83％。并发症发生46例，其中胆漏 8例，术中出血 27例，肝总管横断 1例，术后出 血 12例。全部治愈出院。结论 为减少并发症应严格掌握腹腔镜胆囊切除术(Lc)适应证。肝外胆管损伤是严重并 发症之一，应仔细解剖，特别是Calot三角粘连，解剖困难伴胆囊颈、胆囊管结石嵌顿患者应即时中转开腹，一旦 发生损伤应与有胆道手术经验的医师配合争取一次手术成功。术后监测生命体征和保持腹腔引流通畅。 【关键词】腹腔镜胆囊切除 胆囊三角 中转开腹 [Abstract]Objective Toreducecomplicationsafterlaparoscopiccholecystectomy．Methods Toreviewthe documentsof1697laparoscopiccholecystectomycasesfrom april2004tooctober2008inourhospita1．Results Among this1697laparoscopiccholecystectomycases，agedfrom 14to87yearsold，withaaverageageof50．2，therewere214 casesofgallbladderpolypsand 1483casesofcholecystolithiasis．Amongthecholecyst0lithiasiscases，therewere354 casesofacuteepisodeofchroniccalculouscholecystitisand49casesaccompaniedbycalculusincarcerationatcollum vesicaebiliarisorcysticduct．Therewere18casesofAtrophiccholecystitis，62casestransferredtoopenupabdomen，and 46caseswithcomplicationsthattookup2．83％ ofalllaparoscopiccholecystectomycases．Therewerealso8caseswith biliarycolic，27casesbleedingduringoperation，1caseswithtranssectionofductushepaticuscommunis，nad 12cases bleeding afteroperation．Allcaseswereoutofhospitalwith HW ．Conclusion In ordertoreduce complications， indicationsoflaparoscopiccholecystectomyhastobestrictlycontrolled．Xtrahepaticbileductinjuryisonethemost severecomplications，andthedissectionhastobedonewithextremecare．Especially，patientshavetobetransferredto openupabdomen ifthere isdifficulty indissectionon suchpatientswithCalot’Striangleadherenceaccompna iedby calculusincarcerationatcollumvesicaebiliarisorcysticduct．Oncethereareinjuries，theoperationshouldbedone successfullywithmuchexperienceddoctor．VShastobemonitoredandabdominalcavitydr