客户须知·付款方式·设为首页·加入收藏·网站地图华世论文网

当前位置: 代写毕业论文 >> 临床医学 >> 腹腔镜胆囊切除手术中结石漏入腹腔的原因及处置

腹腔镜胆囊切除手术中结石漏入腹腔的原因及处置

来源:华世论文网
 

           作者:刘天学,徐常青,张桂茹,王永臻

【摘要】  目的:探讨腹腔镜胆囊切除术(LC)中结石漏入腹腔发生的原因及预防。方法:回顾分析512例LC术中结石漏入腹腔患者发生的原因,探讨其预防措施及处理经验。结果:LC术中结石漏入腹腔32例,结石漏入腹腔发生率为6.25%。LC术中结石漏入腹腔后多全部取出,腹腔残留结石患者无腹腔脓肿及窦道形成等并发症出现。结论:预防腹腔漏入结石的关键是LC术中防止胆囊分破或取出时撕破致胆汁、结石漏入腹腔,胆囊分破、结石落入腹腔后采取必要的处理措施,LC术中结石落入腹腔未能全部取出,可严密随访,不必为此中转开腹。

  【关键词】  胆囊切除术,腹腔镜;并发症

  Reasons and administrative ways of gallstone spilling in peritoneal cavity during laparoscopic cholecystectomy

  【Abstract】  Objective:To investigate the reasons and administrative ways of spilling gallstone in peritoneal cavity during laparoscopic cholecycstectomy(LC).Methods:512 patients with gallstone spillage into peritoneal cavity during LC were retrospectively analysed in our unit,and the successfull experiences were summed up for prevention.Results:In this group,there were 32 patients with gallstone spillage during LC,and the incidence of gallstone spillage was about 6.25%.Following up half5years,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.Conclusions:The key step to prevent concretions seeped into abdominal cavity is to avoid gallbladder teared,which leading bile and concretions seep into abdominal cavity.The emergency action to this condition must be taken.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.

  【Key words】  Cholecystectomy,laparoscopy;Complication

  腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)是近年胆囊切除技术的一个飞跃和发展。LC因其创伤小、痛苦轻、术后恢复快、手术切口小美观特点,已成为治疗胆囊良性疾患的首选治疗方法。近年来有关LC术后腹腔残留结石引起腹腔脓肿、窦道形成的个案报道甚多[1,2]。我院自2000年1月行LC 512例,其中结石漏入腹腔32例,现对其原因及处置报道如下。

  1  资料与方法
   
  本院自2000年1月~2006年1月成512例LC,其中男207例,女305例,23~68岁。本组发生结石落入腹腔32例,其发生率为6.25%,其中包括急性胆囊炎伴结石13例、慢性胆囊炎伴结石19例。全组患者均在全麻气腹下行LC。

  2  结果

  手术时间30~125min,平均(45±8)min。其发生原因为:LC术中胆囊壁分破及电凝钩将其钩破所致21例、钳夹胆囊侧胆囊管的钛夹脱落2例、自戳孔取出胆囊时撕破9例。落入腹腔的结石一般采取袋装法、抓捡法、吸引法将结石取出,随访0.5~5年,无腹盆腔脓肿、窦道形成等并发症出现。

  3  讨论

  LC术中腹腔残留结石引起的并发症并非罕见,由于LC的普及,国内外有关LC术后腹腔残留结石引起腹腔脓肿、窦道形成甚至右下肺炎的病例报道甚多;但有关LC术中结石落入腹腔的原因、预防措施方面的文献较少;而有关结石落入腹腔而未能全部取出的是否中转开腹更存争议。

华世论文网(www.lwdx123.com),用心提供代写毕业论文,硕士论文代写,以及省级,国家级,核心职称论文发表,专注论文代写行业十二年,用心服务,诚信第一!
前一篇:腹腔镜辅助超低位直肠癌Parks术37例分析
后一篇:国内腹腔镜阑尾切除术并发症的Meta分析
Powered by www.lwdx123.com © 论文发表 Inc.
Copyright © 1998-2010 Studylw. 中国华世论文网 版权所有
我们的电话是:18952021229. 企业QQ号码:4000290183. 期待您的咨询
代写毕业论文,代写硕士论文,毕业论文代写,硕士论文代写,华世论文网最专业