腹腔镜胆囊切除术术后黄疸的原因及对策(附6例报告)  

Causes and treatment of jaundice in laproscopic cholecystectomy

作　　者：余少鸿[1] 杨杰[1] 李建昌[1] 舒杰 朱磊[1] 罗然[1] 汤荣春[1] 王斌[1] 

机构地区：[1]昆明市第一人民医院甘美医院普外科,650000

出　　处：《中华腔镜外科杂志（电子版）》2017年第4期211-213,共3页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的分析腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)术后黄疸的原因及处理。方法对昆明市第一人民医院2004年1月至2016年5月行LC的3 252例患者进行分析,术后发生黄疸6例,其中发生胆道损伤4例(即胆总管横断1例、肝总管生物夹夹闭不全1例、副右肝管夹闭横断1例、电钩损伤前壁右肝管1例),术后其他原因导致黄疸2例(其中1例术前提示胆囊细小结石,术后1 d出现黄疸,MRCP证实胆管内无结石;1例术后出现黄疸,再次手术证实胆道完整通畅)。6例患者处理:副右肝管夹闭未做处理1例;取出生物夹,行T管支撑引流1例;术后胆瘘1例,术后7 d再次开腹发现右肝管前壁部分坏死,清除坏死组织,T管支撑,大网膜覆盖;术后出现胆瘘及黄疸1例,术后3 d再次开腹发现生物夹夹闭处漏胆,胆总管横断,行坏死组织清除,肝管空肠吻合;1例MRCP证实胆管内无结石行EST后黄疸消失;1例术中证实胆道通畅者放置T管后黄疸减退,3个月后拔除T管。结果所有患者术后随访12~60个月,平均36个月,未出现任何不适,未发现肝脏萎缩及胆道狭窄及其他并发症。结论 LC术后黄疸原因既有胆道损伤的因素也有其他因素,如胆道细小结石排石、生物夹压迫胆道致胆道狭窄;术者对LC潜在危险性缺乏重视、经验不足或者盲目自信、器械使用不当是发生术后黄疸的主要原因。术中避免挤压胆囊,把握中转开腹的时机,可减少术后黄疸的发生。Objective To investigate the etiology and treatment methods of jaundice after laparoscopic cholecystectomy（ LC）. Methods From Jan. 2004 to May 2016,the clinic data of patients in laparoscopic cholecystectomy in our department were analyzed. Results Of the 3 252 cases performed,there were 6（ 0. 18%） cases with jaundice; 6 cases were diagnosed after operation. Of the 6 cases,1 case was no treatment; 1 case was treated by EST; 3 cases were repaired by direct suture and＂T＂type tube to drain and sustain,and 1 case was operated by choledochojejunostomy. Following 12-60 months no cases have severe complications. Conclusions To avoid bile duct injuries,we have to abide by the procedure. The indication of LC（ including emergency） should be mastered strictly. The timely identification and treatment of jaundice can decrease effectively the chance of reoperation.

关 键 词：腹腔镜 胆囊切除术 黄疸 

分 类 号：R657.4[医药卫生—外科学]