Complications following cholecystectomy.
Complications following cholecystectomy.
复制标题
胆囊切除术后的并发症。
DOI：
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发表时间：
1997
期刊：
影响因子：
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通讯作者：
A. Scarduelli
中科院分区：
文献类型：
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作者：
G. Roviaro;M. Maciocco;C. Rebuffat;F. Varoli;V. Vergani;G. Rabughino;A. Scarduelli
腹腔镜胆囊切除术被认为是治疗胆石症的金标准。然而，不可低估可能出现的并发症。从1991年7月1日至1995年11月30日，该科有1005名胆石症患者接受了胆囊切除术。无围手术期死亡。36例（3.6%）改为剖腹手术。在4例（0.4%）患者中，由于严重并发症而强制转换：3例患者在引入套管针时（1例主动脉病变，1例中结肠静脉损伤，1例内脏穿孔），1例患者由于肝门区出血。32例（3.2%）采用选择性转换。这是由于技术困难或胆总管结石（22例），麻醉问题（3例），胆道消化瘘（1例），副肝管胆汁溢出（3例），意外结肠癌（1例），仪器故障（2例）。24例（2.4%）患者出现术后并发症：气胸1例，胆漏2例（胆管损伤1例，胆囊管渗漏1例），腹膜出血8例，膈下脓肿5例，贫血3例，顶内积液3例，双侧基底支气管肺炎1例，十二指肠应激性溃疡穿孔1例。其中，11例患者（1%）接受了再干预：5例再次腹腔镜手术，3例转换手术和3例开腹手术。本研究证明腹腔镜胆囊切除术的安全性。并发症相对较少，通常可以通过保守治疗或再次腹腔镜检查来处理。并发症通常与插入盲套管针或诱导闭合性气腹有关。细致的技术或开放式腹腔镜检查可将这些风险降至最低。归信不应被视为失败，而是面对重大困难时的明智决定。在这些原则下，胆囊切除术是安全的，是胆囊结石的最佳治疗方法。
Laparoscopic cholecystectomy is considered the gold standard for cholelithiasis. Nevertheless possible complications must not be underestimated. In this department, from 1 July 1991 to 30 November 1995, 1005 patients with cholelithiasis underwent videocholecystectomy. There was no peri-operative mortality. In 36 cases (3.6%) the procedure was changed to laparotomy. In four cases (0.4%) conversion was mandatory due to severe complications: in three patients while introducing a trocar (one aortic lesion, one middle colic vein injury and one visceral perforation) and in one patient due to bleeding in the hepatic hilar region. In 32 cases (3.2%) conversion was carried out electively. This was due to technical difficulties or to choledocholithiasis (22 patients), anaesthesiological problems (three cases), biliodigestive fistula (one), bile spillage from accessory hepatic ducts (three), unexpected colonic cancer (one), instrument malfunction (two cases). Twenty-four patients (2.4%) experienced post-operative complications: one with pneumothorax, two with bile leakage (one bile duct damage, and one cystic duct leakage), eight with haemoperitoneum, five with subphrenic abscess, three with anaemia, three with intraparietal collections, one with bilateral basal bronchopneumonia, one with perforated duodenal stress ulcer. Of these, 11 patients (1%) underwent reintervention: five re-laparoscopies, three conversions, and three open laparotomies. This study demonstrates the safety of videolaparocholecystectomy. Complications are relatively rare and can be often dealt with conservative treatment or re-laparoscopy. Complications are often linked to insertion of a blind trocar or to the induction of a closed pneumoperitoneum. Meticulous technique or open laparoscopy minimize these risks. Conversion must not be considered a defeat but a wise decision in the face of major difficulties. Under these principles, videocholecystectomy is safe and represents the best treatment of gallbladder stones.