摘要:目的:探討腹腔鏡膽囊切除術(shù)(laparoscopic cholecystectomy, LC)后發(fā)生嚴(yán)重并發(fā)癥的原因、治療措施和經(jīng)驗(yàn)教訓(xùn)。方法:分析 2007 年 8 月至2009 年 4月期間華西醫(yī)院膽道外科收治的LC術(shù)后發(fā)生嚴(yán)重并發(fā)癥的7例患者的臨床資料。結(jié)果:2例繼發(fā)性膽總管結(jié)石合并化膿性膽管炎患者,采用內(nèi)鏡下十二指腸乳頭切開(kāi)(endoscopic sphincterotomy, EST)取出結(jié)石;3例膽道損傷患者,均進(jìn)行肝門(mén)膽管成形和肝總管空腸吻合術(shù);1例絞窄性腸梗阻患者,切除壞死空腸管后,行空腸對(duì)端吻合術(shù);以上6例患者均順利出院,隨訪8～20個(gè)月,均生活良好。1例患者LC術(shù)后發(fā)生肺動(dòng)脈栓塞,積極搶救后因呼吸衰竭而死亡。結(jié)論:術(shù)中仔細(xì)輕柔的操作以及辯清肝總管、膽總管與膽囊管的三者關(guān)系是預(yù)防LC術(shù)后發(fā)生嚴(yán)重并發(fā)癥的關(guān)鍵。合理可行的治療措施是提高發(fā)生并發(fā)癥的患者生活質(zhì)量的保障。LC術(shù)時(shí),膽道外科醫(yī)生思想上要高度重視,不可盲目追求速度,必要時(shí)及時(shí)中轉(zhuǎn)開(kāi)腹。
Abstract: Objective: To investigate the causes and therapeutic measures and the experience and lesson of sever complications after laparoscopic cholecystectomy (LC). Methods:Clinical data of 7 patients with severe complications after LC from August 2007 to April 2009 were analyzed retrospectively. The clinical data was got from biliary department of West China Hospital. Results: Two cases of secondary common bile duct stone with acute suppurative cholangitis got cured by endoscopic sphincterotomy. Three cases of severe bile duct injury after LC had stricture of the hilar bile duct, and all of the cases were performed RouxenY hepaticojejunostomy with the diameter of stoma 2.03.0 centimeters. One case of strangulating intestinal obstruction was cured through jejunum endtoend anastomosis after cutting off the necrotic jejunum. All of the above 6 patients recovered well. Following up for 820 months, all lived well. One patient got pulmonary embolism after LC and dead of respiratory failure after active rescue. Conclusion: Carefully making operation and distinguishing the relationship of hepatic bile duct and common bile duct and the duct of gallbladder are the key points to prevent sever complications during LC. Reasonable and feasible treatment is the ensurement of increasing the living quality of the patients with sever complications after LC. And the surgeons of biliary department must have a correct attitude toward LC and should concern think highly during LC and should not pursue speed blindly. In necessary, the operation of LC should be turned into open cholecystectomy.

引用本文： 黃忠華,趙東,程南生,熊先澤. 腹腔鏡膽囊切除術(shù)后發(fā)生嚴(yán)重并發(fā)癥的臨床分析. 華西醫(yī)學(xué), 2009, 24(11): 2856-2858. doi: 復(fù)制