腹腔镜胆囊切除术胃肠道损伤的临床分析  

The reasons and countermeasures of digestive duct injury in laparoscopic cholecystectomy

作　　者：李冬生[1] 彭艺[1] 刘庆模[1] 

机构地区：[1]信宜市人民医院,广东信宜525300

出　　处：《基层医学论坛》2008年第23期673-675,共3页The Medical Forum

摘　　要：目的探讨LC胃肠道损伤的原因、预防措施及处理方法。方法回顾分析1998年9月-2007年9月我院1000例LC术中胃肠道损伤的原因及处理方法,探讨其预防措施及处理成功的经验。结果本组病例共5例胃肠道损伤(占0.5%),其中胃窦部损伤、十二指肠球部损伤及回肠损伤各1例,空肠损伤2例。术中发现3例,当即中转开腹行损伤脏器修补术;术后18h及5d因急性腹膜炎发现各1例,再次剖腹探查行损伤脏器修补及腹腔引流术。全部患者均痊愈出院,无严重并发症出现。结论LC术中气腹针盲穿、锐利器械暴力插入腹腔盲区、电凝钩反弹是致胃肠道损伤的主要原因;LC术后出现急性弥散性腹膜炎症状,考虑到胃肠道损伤并恰当处理是改善患者预后的关键。Objective To investigate the reasons, preventive measures and treatment of digestive duct injury in laparoscopic cholecystectomy （LC）.Methods The reasons of digestive duct injury were retrospectively analysed in 1 000 cases of LC in our unit From September 1998 to September 2007. The successful experience of treatment in these patients was summed up.Results In this group, there was 1 case of gastric antrum, duodenal bulbar injury and ileal injury each and 2 cases of jejuna injury. Three cases of them were found in LC and required conversion to open operation and injured digestive duct repairment, Two cases were affected with acute peritonitis 18 hours after LC and 5 days after required digestive duct repairment and peritoneal cavity drainage. All patients were recovered and discharged. No severe complications were found in patients of this group.Conclusion Not conforming to the rules of closed establishment in pneumoperitoneum, sharp device entering peritoneal blind area ＂with violence＂and tip of electrocoagulation device springing up adversely are the main reasons of digestive duct injury in LC. Finding acute peritonitis post LC, intestinal duct injury should be considered. Right diagnosis and proper treatment are the key to improving the patients＇prognosis of digestive duct injury post LC.

关 键 词：胆囊切除术 腹腔镜 并发症 胃肠道损伤 

分 类 号：R657.4[医药卫生—外科学] R971.1[医药卫生—临床医学]