Rice D C, Memon M A, Jamison R L, Agnessi T, Ilstrup D, Bannon M B, Farnell M B, Grant C S, Sarr M G, Thompson G B, Zietlow S P, Donohue J H
Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA.
J Gastrointest Surg. 1997 Jan-Feb;1(1):85-90; discussion 90-1. doi: 10.1007/s11605-006-0014-x.
Laparoscopic cholecystectomy is associated with a higher incidence of iatrogenic perforation of the gallbladder than open cholecystectomy. The long-term consequences of spilled bile and gallstones are unknown. Data were collected prospectively from 1059 consecutive patients undergoing laparoscopic cholecystectomy over a 3-year period. Details of the operative procedures and postoperative course of patients in whom gallbladder perforation occurred were reviewed. Long-term follow-up (range 24 to 59 months) was available for 92% of patients. Intraoperative perforation of the gallbladder occurred in 306 patients (29%); it was more common in men and was associated with increasing age, body weight, and the presence of omental adhesions (each P < 0.001). There was no increased risk in patients with acute cholecystitis (P = 0.13). Postoperatively pyrexia was more common in patients with spillage of gallbladder contents (18% vs. 9%; P < 0.001). Of the patients with long-term follow-up, intra- abdominal abscess developed in 1 (0.6%) of 177 with spillage of only bile, and in 3 (2.9%) of 103 patients with spillage of both bile and gallstones, whereas no intra- abdominal abscesses occurred in the 697 patients in whom the gallbladder was removed intact ( P < 0.001). Intraperitoneal spillage of gallbladder contents during laparoscopic cholecystectomy is associated with an increased risk of intra-abdominal abscess. Attempts should be made to irrigate the operative field to evacuate spilled bile and to retrieve all gallstones spilled during the operative procedure.
与开腹胆囊切除术相比，腹腔镜胆囊切除术导致医源性胆囊穿孔的发生率更高。胆汁和胆结石溢出的长期后果尚不清楚。在3年期间，前瞻性收集了1059例连续接受腹腔镜胆囊切除术患者的数据。对发生胆囊穿孔患者的手术过程和术后病程细节进行了回顾。92%的患者获得了长期随访（范围为24至59个月）。306例患者（29%）发生术中胆囊穿孔；在男性中更常见，并且与年龄增长、体重增加和存在网膜粘连有关（均P<0.001）。急性胆囊炎患者的风险没有增加（P=0.13）。胆囊内容物溢出的患者术后发热更常见（18%对9%；P<0.001）。在长期随访的患者中，仅胆汁溢出的177例中有1例（0.6%）发生腹腔脓肿，胆汁和胆结石均溢出的103例患者中有3例（2.9%）发生腹腔脓肿，而697例胆囊完整切除的患者中未发生腹腔脓肿（P<0.001）。腹腔镜胆囊切除术期间胆囊内容物的腹腔内溢出与腹腔脓肿风险增加有关。应尝试冲洗手术视野以清除溢出的胆汁，并取出手术过程中溢出的所有胆结石。
