Dubois F, Levard H, Berthelot G, Mouro J, Karayel M
CMC Porte de Choisy, Paris.
Ann Chir. 1994;48(10):899-904.
The development of laparoscopic cholecystectomy is only justified if it can ensure the good results obtained by laparotomy. The purpose of this work is to study all complications which occurred in a homogeneous group of patients. From May 1988 to January 1993, we operated on 2006 patients by laparoscopy (724 men and 1282 women) with a mean age of 50.6 years. Signs of stones in the common bile duct were noted in 4.1% and acute cholecystitis was detected in 12.5%. A conversion to normal laparotomy was necessary in 2.1% of patients. All complications were systematically investigated restrospectively in any patient hospitalised for more than five days. Residual stones in the common bile duct were not taken into consideration when they were not complications obviously related to the operation. We observed five intraoperative complications (4 hemorrhages, 1 ileum puncture) and 40 postoperative complications (25 non biliary and 15 biliary). The 25 non biliary complications consisted of: 1 death by pulmonary embolism, 9 hemorrhages, 4 cases of acute pancreatitis, 4 subphrenic abscesses, 2 colon punctures, 2 parietal complications, 1 ulcer perforation, 1 myocardial infarction and 1 phlebitis. The 15 biliary complications consisted of: 3 lateral punctures of the common bile duct, 9 fistulas of the cystic duct (4 with a residual stone in the common bile duct and 5 without), 2 punctures of an abnormal right hepatic duct, one of which was treated by "Roux en Y loop" intestinal diversion, and a late stenosis of the common bile duct.(ABSTRACT TRUNCATED AT 250 WORDS)
只有在能确保开腹手术所取得的良好效果时,腹腔镜胆囊切除术的发展才是合理的。本研究的目的是探讨一组同质患者中发生的所有并发症。1988年5月至1993年1月,我们对2006例患者进行了腹腔镜手术(724例男性,1282例女性),平均年龄50.6岁。胆总管结石体征的发生率为4.1%,急性胆囊炎的检出率为12.5%。2.1%的患者需要转为常规开腹手术。所有住院超过五天的患者都对其并发症进行了系统回顾性调查。当胆总管残余结石并非明显与手术相关的并发症时,不将其纳入考虑范围。我们观察到5例术中并发症(4例出血,1例回肠穿刺)和40例术后并发症(25例非胆源性和15例胆源性)。25例非胆源性并发症包括:1例因肺栓塞死亡、9例出血、4例急性胰腺炎、4例膈下脓肿、2例结肠穿刺、2例腹壁并发症、1例溃疡穿孔、1例心肌梗死和1例静脉炎。15例胆源性并发症包括:3例胆总管侧壁穿刺、9例胆囊管瘘(4例胆总管有残余结石,5例无)、2例异常右肝管穿刺,其中1例通过“Roux-en-Y肠袢”肠转流术治疗,以及1例胆总管晚期狭窄。(摘要截断于250字)