Smith R, Kolyn D, Pymar H, Sauerbrei E, Pace R F
Department of Surgery, Kingston General Hospital, Queen's University, Ont.
Can J Surg. 1992 Feb;35(1):55-8.
The first 30 patients scheduled to undergo laparoscopic cholecystectomy at the Kingston General Hospital, Kingston, Ont., were studied by abdominal ultrasonography and abdominal roentgenography 24 hours after the procedure. The ultrasonogram appeared normal in 21 of the 29 patients in whom laparoscopic cholecystectomy was successful. In six of the eight patients with an abnormal ultrasonogram a tiny collection of fluid was identified in the gallbladder fossa; in two patients retained intraperitoneal stones were identified (one of these patients also had a small fluid loculus); and one patient had a small amount of free fluid in Morrison's pouch. This last patient was subsequently found to have a retained common-bile-duct stone, which required endoscopic removal. Plain films showed moderate to large amounts of retained gas intraperitoneally in only three patients. Colonic distension was recorded in 23 of the 28 patients studied, suggesting a partial colonic ileus. Residual pneumoperitoneum and colonic distension did not correlate with any untoward clinical findings. This study demonstrates that most patients have complete reabsorption of their pneumoperitoneum within 24 hours of laparoscopic cholecystectomy and that small amounts of fluid in the gallbladder fossa and mild to moderate colonic distension are not significant in terms of operative complications.
对安大略省金斯顿市金斯顿综合医院计划接受腹腔镜胆囊切除术的首批30例患者，在术后24小时进行了腹部超声检查和腹部X线检查。在成功进行腹腔镜胆囊切除术的29例患者中，21例超声检查结果正常。在超声检查异常的8例患者中，6例在胆囊窝发现少量积液；2例发现腹腔内有残留结石（其中1例患者也有小的液性暗区）；1例患者在肝肾隐窝有少量游离液体。该例患者随后被发现有胆总管残留结石，需通过内镜取出。腹部平片仅在3例患者中显示腹腔内有中度至大量残留气体。在接受检查的28例患者中，23例记录有结肠扩张，提示存在部分结肠麻痹性肠梗阻。残留气腹和结肠扩张与任何不良临床发现均无关联。本研究表明，大多数患者在腹腔镜胆囊切除术后24小时内气腹完全吸收，胆囊窝内少量积液以及轻至中度结肠扩张对手术并发症而言并无重要意义。
