用腹腔镜处理腹腔镜胆道手术并发症(附9例报告)  

LAPAROSCOPIC MANAGEMENT OF 9 SERIOUS COMPLICATIONS DURING 1 500 CASES OF LAPAROSCOPIC BILIARY OPERATIONS

作　　者：尹思能[1] 李青亮[1] 张诗诚[1] 陈先林[1] 

机构地区：[1]成都市第二人民医院肝胆胰外科

出　　处：《中国普外基础与临床杂志》1999年第3期168-169,共2页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：对腹腔镜胆道手术的并发症，国内外术者多采用开腹方式处理。我院从１９９５年１２月至１９９７年１２月，共行腹腔镜胆道手术１５００例，发生并发症９例（０．６％），其中大胆管损伤３例（０．２％），胃十二指肠损伤３例（０．２％），其他３例（０．２％）。该９例均分别于术中和术后早期发现，用腹腔镜处理均取得了满意的效果。笔者认为：对于腹腔镜手术并发症，只要是发现及时，且腹腔操作技术熟练，即使是比较复杂和比较严重的并发症，仍然可以尝试用腹腔镜探查和处理。From December 1995 to December 1997, 1 500 patients with gallstones or together with biliary duct stones accepted laparoscopic cholesystectomy (LC) or LC+laparoscopic common bile duct exploration (LCDE). There were 9 had serious complications (0.6%) occured . While the mean age was 54.9 years old. The sex ratio (female∶male) was 1∶1.25. Three cases had major biliary duct disruption, 1 case had stomach perforation, 2 cases had duodenal injuries, 1 bleeding case because cystic artery fail to clip, 1 case had postoperative cystic duct leak, and 1 case with T tube dislodgement. All complications had been discovered during or shortly after operations. The injuries on the extrahepatic biliary duct with lengths of 0.2-0.4cm, and the gastrodenal injuries sized 0.5-1.0cm. All of the injuries had been sutured laparoscopically without sequela. The one who had postoperative cystic duct leak and jaundice accepted LCDE, proved to have a common bile duct stone. The bleeding cystic artery had been clipped well, and the dislodged T tube replaced well. The results show if the complications which may be very serious or complex had been discovered shortly after or during the operations, its can be managed with laparoscopic technique safely by experienced operators.

关 键 词：腹腔镜 胆道手术 术后并发症 胆总管损伤 

分 类 号：R657.420.5[医药卫生—外科学] R619[医药卫生—临床医学]