摘要:目的:探討腹腔鏡膽囊切除術(laparoscopic cholecystectomy, LC)后發生嚴重并發癥的原因、治療措施和經驗教訓。方法:分析 2007 年 8 月至2009 年 4月期間華西醫院膽道外科收治的LC術后發生嚴重并發癥的7例患者的臨床資料。結果:2例繼發性膽總管結石合并化膿性膽管炎患者,采用內鏡下十二指腸乳頭切開(endoscopic sphincterotomy, EST)取出結石;3例膽道損傷患者,均進行肝門膽管成形和肝總管空腸吻合術;1例絞窄性腸梗阻患者,切除壞死空腸管后,行空腸對端吻合術;以上6例患者均順利出院,隨訪8～20個月,均生活良好。1例患者LC術后發生肺動脈栓塞,積極搶救后因呼吸衰竭而死亡。結論:術中仔細輕柔的操作以及辯清肝總管、膽總管與膽囊管的三者關系是預防LC術后發生嚴重并發癥的關鍵。合理可行的治療措施是提高發生并發癥的患者生活質量的保障。LC術時,膽道外科醫生思想上要高度重視,不可盲目追求速度,必要時及時中轉開腹。Abstract: Objective: To investigate the causes and therapeutic measures and the experience and lesson of sever complications after laparoscopic cholecystectomy (LC). Methods:Clinical data of 7 patients with severe complications after LC from August 2007 to April 2009 were analyzed retrospectively. The clinical data was got from biliary department of West China Hospital. Results: Two cases of secondary common bile duct stone with acute suppurative cholangitis got cured by endoscopic sphincterotomy. Three cases of severe bile duct injury after LC had stricture of the hilar bile duct, and all of the cases were performed RouxenY hepaticojejunostomy with the diameter of stoma 2.03.0 centimeters. One case of strangulating intestinal obstruction was cured through jejunum endtoend anastomosis after cutting off the necrotic jejunum. All of the above 6 patients recovered well. Following up for 820 months, all lived well. One patient got pulmonary embolism after LC and dead of respiratory failure after active rescue. Conclusion: Carefully making operation and distinguishing the relationship of hepatic bile duct and common bile duct and the duct of gallbladder are the key points to prevent sever complications during LC. Reasonable and feasible treatment is the ensurement of increasing the living quality of the patients with sever complications after LC. And the surgeons of biliary department must have a correct attitude toward LC and should concern think highly during LC and should not pursue speed blindly. In necessary, the operation of LC should be turned into open cholecystectomy.
摘要:目的:探討床旁超聲檢查在肝移植術后下腔靜脈(IVC)并發癥診斷中的應用價值。方法:對424例肝移植術后患者進行床旁超聲檢查,對下腔靜脈并發癥,包括狹窄及栓塞的資料進行回顧性分析和總結。結果:床旁超聲檢查發現下腔靜脈并發癥患者18例,其中狹窄6例,栓塞12例。結論:床旁超聲檢查在肝移植術后,尤其是對術后早期發生的下腔靜脈并發癥的診斷及監測具有重要的作用,為臨床診斷和治療提供及時、有價值的影像學依據。Abstract: Objective: To evaluate the value of bedside ultrasound in diagnosis and monitoring of inferior vena cava (IVC) complications after liver transplantation. Methods: 424 cases with liver transplantation were examined by bedside ultrasound after the operations. The results of IVC complications,including thrombosis and stenosis, were analyzed and summarized. Results: 18 cases with IVC complications were detected by bedside ultrasound, including 6 cases of stenosis and 12 cases of thrombosis. Conclusion: Bedside ultrasound is important for diagnosing and monitoring IVC thrombosis and stenosis after liver transplantation, especially in the earlier period. It could provide valuable imaging for clinical diagnosis and treatment promptly.
