摘要
目的 探讨腹腔镜胆囊切除术 (L C)结石漏入腹腔发生的原因、预防措施及处理方法。方法 回顾分析了 1991年 9月～ 1999年 12月 72 0 0例 L C术中结石漏入腹腔患者发生的原因 ,探讨其临床预防措施及处理成功的经验。结果 L C术中结石漏入腹腔 36 3例 ,其中 L C术中胆囊分破所致 2 19例 ,钳夹胆囊侧胆囊管钛铗脱落所致 43例 ,自腹壁戳孔取出时撕破34例 ,分离钳扩开戳孔时刺破 6 7例 ,结石漏入腹腔发生率约为 5 %。L C术中结石漏入腹腔后多全部取出 ,腹腔残留结石患者确切数目不甚清楚 ,随访 1～ 8年无腹腔脓肿、窦道形成等并发症出现。结论 L C术中胆囊分破、钳夹胆囊侧胆囊管的钛铗碰落、自腹壁戳孔取出时用力撕破或胆囊取出时因戳孔过小扩开时刺破是 L C术中结石漏入腹腔的主要原因。L C术中一旦结石脱入腹腔采取必要的方法全部取出是减少或避免腹腔残石发生的主要措施。 L C术中结石脱入腹腔未能全部取出 ,可严密观察随访 。
Objective To investigate the reasons and administrative ways of spilling gallstone in peritoneal cavity during laparoscopic cholecycstectomy(LC).Methods Between September 1991 and December 1999,7200 patients with gallstone spillage into peritoneal cavity during LC were retrospectively analysed in our unit,and the successfull experiences were summed up for preventon.Results In this group,there were 363 patients with gallstone spillage during LC,and the incidence of gallstone spillage was about 5%.In these patients,219 cases were because of cutting into the wall of the gallbladder when it is being dissected away from the liver.43cases were because of dislodgement of the clip from the gallbladder side of the cystic duct,and other 67 cases were because of applying excessive force on the gallbladder during extraction through too narrow abdominal orifice,other 67 cases were because of gallbladder perforation puncture by forceps during enlarging abdominal orifice.But the true incidence of retained stones during LC is diffcult to determine in this group.Following up 1～8 years ,there were not complications secondary to these spilled stones such as peritoneal abscess,stone migration through retroperitoneum to a previous surgical wound or mechanical small obstruction.Conclusion Gallbladder perforation by puncture during dissection,forceful retration on the gallbladder during dissection resulting in tearing the gallbladder,dislodgement of the clip from the gallbladder side of the cystic duct and applying excessive force on the gall bladder during extraction through anterior abdominal orifice are the main reason of spillage gallstones during LC.In order to avoid some complication related to spilled stones during LC,various effort should be made to remove them.However,it is not recommended to perform laparotomy in order to remove all spillage gallstones during LC because most retained stones are harmless to patients.
出处
《肝胆外科杂志》
2001年第2期118-120,共3页
Journal of Hepatobiliary Surgery
关键词
腹腔镜
胆囊切除术
并发症
腹腔
残留结石
Laparoscopy
Cholecystectomy
Complication
Peritoneum
Retained stones
