胆囊切除术并发症原因剖析及预防.docVIP

胆囊切除术并发症原因剖析及预防 　　doi：10.3969/j.issn.1007-614x.2014.20.37 　　摘 要 目的：探讨胆囊切除术并发症的发生原因及其预防对策。方法：2003年12月-2013年12月收治胆囊切除术患者1 542例，其中开腹胆囊切除手术（OC）患者861例，腹腔镜胆囊切除手术（LC）患者681例。结果：其中胆管损伤1例，十二指肠损伤1例，切口脂肪液化3例，切口感染3例，空肠损伤1例，胆囊管残留结石1例，胆总管残留结石1例，胆漏1例，出血2例，LC中转开腹手术5例，余手术进展顺利。结论：术前对患者的病情评估、合理选择病例、恰当掌握好手术时机、谨慎规范的手术操作、果断及时地中转开腹可有效地防止和减少胆囊切除术并发症的发生率，尤其是在防范腹腔镜胆囊切除术后所致的严重并发症非常重要。 　　关键词 开腹 腹腔镜 胆囊切除术 并发症 原因 预防 　　Analysis and prevention of complications of cholecystectomy 　　Pang Linglie，Liu Hongxia，Li Chunguang，Hou Zongsheng 　　The Traditional Chinese Medicine Hospital of Xuanhan County，Sichuan 636150 　　Abstract Objective：To explore the causes and the preventive measures of complications of cholecystectomy（LC and OC）.Methods：1542 cases with cholecystectomy were selected from December 2003 to December 2013.861 cases were cholecystectomy operation.681 cases were laparoscopic cholecystectomy operation.Results：Among them，1 case had bile duct injury.1 case had duodenal injury.3 cases had incision fat liquefaction.3 cases had incision infection.1 case had cystic duct jejunum injury.1 case had residual common bile duct calculi.1 case had residual stones.1 case had bile leakage.2 cases had hemorrhage.5 cases were converted to open operation in LC.The rest of the operation was smooth.Conclusion：Before operation，the evaluation of patients condition，proper selection of cases，appropriate master operation time，cautious operation specification，decisive and timely conversion to open surgery can effectively prevent and reduce the incidence of complications of cholecystectomy，especially in the prevention of severe complications of laparoscopic cholecystectomy. 　　Key words Laparotomy；Laparoscope；Cholecystectomy；Complication；Reason；Prevention 　　开腹胆囊切除术（OC）已有100多年的历史，该手术目前虽然在大中型医院基本上被腹腔镜手术所取代，但在相当多的基层医院，因其设备昂贵，手术费用相对较高，医生腔镜技术培训的限制，仍在行开腹胆囊切除术。开腹胆囊切除手术虽是一种成熟安全的手术，但在术中、术后仍发生诸多并发症，如胆管损伤，术中、术后出血，十二指肠损伤，结肠损伤，切口感染、脂肪液化等。腹腔镜胆囊切除术（LC）也有20多年的历史，因其具有损创伤小、手术时间短、恢复快等优点，在我国普遍开展，早期在临床实践中并发症的发生率高于OC手术，近十年来随着腔镜技术日益成熟，L