关键词：腹腔镜胆道手术；并发症；腹腔镜处理
摘要 对腹腔镜胆道手术的并发症，国内外术者多采用开腹方式处理。我院从1995年12月至1997年12月，共行腹腔镜胆道手术1500例，发生并发症9例(0.6%)，其中大胆管损伤3例(0.2%)，胃十二指肠损伤3例(0.2%)，其他3例(0.2%)。该9例均分别于术中和术后早期发现，用腹腔镜处理均取得了满意的效果。笔者认为： 对于腹腔镜手术并发症，只要是发现及时，且腹腔操作技术熟练，即使是比较复杂和比较严重的并发症，仍然可以尝试用腹腔镜探查和处理。
LAPAROSCOPIC MANAGEMENT OF 9 SERIOUSCOMPLICATIONS DURING 1 500 CASES OF LAPAROSCOPIC BILIARY OPERATIONS
Yin Sineng, Li Qingliang, Zhang Shicheng, et al. Department of Hepatobiliary Surgery, The Second People's Hospital of Chengdu City, Chengdu 610017
Abstract From December 1995 toDecember 1997, 1 500 patients with gallstones or together with biliary duct stonesaccepted laparoscopic cholesystectomy (LC) or LC+laparoscopic common bile duct exploration (LCDE). There were 9 had serious complications (0.6%) occured . While the mean age was54.9 years old. The sex ratio (female∶male) was 1∶1.25. Three cases had major biliaryduct disruption, 1 case had stomach perforation, 2 cases had duodenal injuries, 1 bleedingcase because cystic artery fail to clip, 1 case had postoperative cystic duct leak, and 1case with T-tube dislodgement. All complications had been discovered during or shortlyafter operations. The injuries on the extrahepatic biliary duct with lengths of 0.2-0.4cm,and the gastrodenal injuries sized 0.5-1.0cm. All of the injuries had been suturedlaparoscopically without sequela. The one who had postoperative cystic duct leak andjaundice accepted LCDE, proved to have a common bile duct stone. The bleeding cysticartery had been clipped well, and the dislodged T-tube replaced well. The results show ifthe complications which may be very serious or complex had been discovered shortly afteror during the operations, its can be managed with laparoscopic technique safely byexperienced operators.
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