Jabbari Nooghabi Azadeh, Hassanpour Masoumeh, Jangjoo Ali
Surgical Oncology Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Surg Laparosc Endosc Percutan Tech. 2016 Jun;26(3):183-92. doi: 10.1097/SLE.0000000000000274.
Laparoscopic cholecystectomy (LC) has become a popular and widespread procedure for the treatment of gallstone disease. There is still an increasing concern about specific complications of LC due to gallbladder perforation and spillage of bile and stones. Although unretrieved intraperitoneal gallstones rarely become symptomatic, their infective complications may cause serious morbidities even after a long interval from LC.
We performed a review of the literature on the diagnosis, prevention, consequences, and management of lost gallstones. All studies with a focus on lost gallstones or perforated gallbladder were analyzed to evaluate the postoperative complications.
Between 1991 and 2015, >250 cases of postoperative complications of spilled gallstones were reviewed in the surgical literature. The most common complications are intraperitoneal abscesses and fistulas. Confusing clinical pictures due to gallstones spreading in different locations makes diagnosis challenging. Even asymptomatic dropped gallstones may masquerade intraperitoneal neoplastic lesions.
Every effort should be made to prevent gallbladder perforation; otherwise, they should be retrieved immediately during laparoscopy. In cases with multiple large spilled stones or infected bile, conversion to open surgery can be considered. Documentation in operative notes and awareness of patients about lost gallstones are mandatory to early recognition and treatment of any complications.
腹腔镜胆囊切除术（LC）已成为治疗胆结石疾病的一种流行且广泛应用的手术。由于胆囊穿孔以及胆汁和结石的溢出，LC的特定并发症仍日益受到关注。尽管腹腔内未取出的胆结石很少出现症状，但即使在LC术后很长一段时间，其感染性并发症也可能导致严重的发病情况。
我们对有关丢失胆结石的诊断、预防、后果及处理的文献进行了综述。分析了所有聚焦于丢失胆结石或胆囊穿孔的研究，以评估术后并发症。
1991年至2015年期间，外科文献中回顾了超过250例胆结石溢出的术后并发症病例。最常见的并发症是腹腔内脓肿和瘘管。胆结石在不同部位扩散导致的临床症状混淆，使得诊断具有挑战性。即使无症状的掉落胆结石也可能伪装成腹腔内肿瘤性病变。
应尽一切努力预防胆囊穿孔；否则，在腹腔镜检查期间应立即将其取出。对于有多个大的溢出结石或感染胆汁的病例，可考虑转为开放手术。手术记录中的记录以及患者对丢失胆结石的知晓对于早期识别和治疗任何并发症至关重要。
