Duca S, Bãlã O, Al-Hajjar N, Lancu C, Puia I C, Munteanu D, Graur F
Training Center in Laparoscopic Surgery, Romanian Society of Laparoscopic Surgery, Cluj, Romania.
HPB (Oxford). 2003;5(3):152-8. doi: 10.1080/13651820310015293.
Even though laparoscopic cholecystectomy (LC) has become the customary method for treating gallstones, some incidents and complications appear rather more frequently than with the open technique. Several aspects of these complications and their treatment possibilities are analysed.
Over the last 9 years 9542 LCs have been performed at this centre, of which 13.9% were carried out for acute cholecystitis, 38.4% in obese patients and 7.6% in patients aged >65 years.
The main operative incidents encountered were haemorrhage (224 cases, 2.3%), iatrogenic perforation of the gallbladder (1517 cases, 15.9%) and common bile duct (CBD) injuries (17 cases, 0.1%). Conversion to open operation was necessary in 184 patients (1.9%), usually due to obscure anatomy as a result of acute inflammation. The main postoperative complications were bile leakage (54 cases), haemorrhage (15 cases), sub-hepatic abscess (10 cases) and retained bile duct stones (11 cases). Ten deaths were recorded (0.1%).
Most of the postoperative incidents (except bile duct injuries) were solved by laparoscopic means. Among patients with postoperative complications 28.9% required revisional surgery. In 42.2% of cases minimally invasive procedures were used successfully: 15 laparoscopic re-operations (for choleperitoneum, haemoperitoneum and subhepatic abscess) and 22 endoscopic sphincterotomies (for bile leakage from the subhepatic drain and for retained CBD stones soon after operation). The good results obtained allow us to recommend these minimally invasive procedures in appropriate patients.
尽管腹腔镜胆囊切除术（LC）已成为治疗胆结石的常用方法，但某些事件和并发症的出现频率比开放手术更高。本文分析了这些并发症的几个方面及其治疗可能性。
在过去9年中，该中心共进行了9542例LC手术，其中13.9%用于治疗急性胆囊炎，38.4%用于肥胖患者，7.6%用于65岁以上患者。
主要的手术事件包括出血（224例，2.3%）、医源性胆囊穿孔（1517例，15.9%）和胆总管（CBD）损伤（17例，0.1%）。184例患者（1.9%）需要转为开放手术，通常是由于急性炎症导致解剖结构不清。主要的术后并发症包括胆漏（54例）、出血（15例）、肝下脓肿（10例）和残留胆管结石（11例）。记录到10例死亡（0.1%）。
大多数术后事件（胆管损伤除外）通过腹腔镜手段解决。在术后并发症患者中，28.9%需要再次手术。在42.2%的病例中，微创程序成功应用：15例腹腔镜再次手术（用于胆汁性腹膜炎\腹腔积血和肝下脓肿）和22例内镜括约肌切开术（用于肝下引流管胆漏和术后不久残留的CBD结石）。取得的良好结果使我们能够在合适的患者中推荐这些微创程序。
