5044例电视腹腔镜胆囊切除术的临床分析

目的探讨腹腔镜胆囊切除术的手术原则及并发症的预防。方法收集我院1992～2002年完成的5044例腹腔镜胆囊切除术的临床资料，分析行腹腔镜胆囊切除病人的原发疾病种类，手术引起的近期及远期并发症。结果5044例腹腔镜胆囊切除术病人中最多的是慢性胆囊炎合并胆囊结石，占84．75％；急性胆囊炎伴胆囊结石186例，占3．69％。中转开腹手术93例，占1．84％。手术并发症中，最严重的为手术中胆管损伤，共9例，发生率0．18％；术后胆漏12例，发生率0．24％；术后出血5例，发生率0.10％。晚期并发症包括胆总管残余结石8例，胆管狭窄6例。无死亡病例。结论腹腔镜胆囊切除术是胆囊疾病的最佳选择，操作技术仍然较复杂，胆总管损伤的发生率较高。细致的操作及配合手术中胆道造影可以减少胆管损伤的发生。

Clinical analysis of 5044 cases receiving laparoscopic cholecystectomy

Objective To investigate the rule for laparoscopic cholecystectomy (LC) and prevention of its complications. Methods The clinical data of ~5 044 patients receiving LC in our hospital from 1992 to 2002 were retrospectively analyzed to determine the types of primary diseases, intraoperative complications and late-stage complications. Results The most frequent primary disease for LC was gallstone with chronic cholecystitis (84.75%). Of all the patients, 186 were with acute cholecystitis accompanied by gallstone (3.69%). The rate of conversion to laparotomy was 1.84%. Bile duct injury happened in 9 patients (0.18%). Postoperative cavity bleeding was found in 5 (0.01%) and bile leakage in 12 (0.24%). Late-stage complications included residual stone in common bile duct (8 cases) and bile duct stricture (6 cases). The mortality for the 5044 patients was 0. Conclusions LC is suitable for most gallbladder diseases. However, its procedure is still complicated and occurring rate of the complication of bile duct injury is high. Favorable results seem to depend on multiple training of LC procedure and intraoperative cholangiography.