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Reason and Treatment of Complications of Hemorrhage after Laparoscopic Cholecystectomy

目的探討腹腔鏡膽囊切除術(LC)后并發出血的原因與正確的防治方法。方法對1992年10月至2005年2月我院進行的LC術后并發出血的37例患者的臨床資料進行回顧性分析。結果膽囊動脈出血21例，膽囊床出血4例，網膜出血6例，trocar穿刺孔出血4例，不明出血部位2例。直接開腹手術7例，腹腔鏡再次手術止血并獲成功21例，腹腔鏡止血失敗中轉開腹手術4例，非手術止血成功5例。36例順利恢復出院，死亡1例。隨訪36例（其中失訪1人），恢復良好。結論LC術后并發出血的原因多種多樣，但多為膽囊動脈出血； 治療以腹腔鏡再次探查止血為主，但不能忽視非手術治療的重要性。

Treatment of Cystic Duct Stone Using Laparoscopic Cholecystectomy and Prevention of Complications

目的 探討腹腔鏡下膽囊管結石的處理方法及并發癥的預防。方法在2002年5月至2005年5月期間施行腹腔鏡膽囊切除術（LC） 6 220例，其中膽囊管結石265例，對此進行回顧性分析。結果順利完成LC 256例，中轉開腹9例，無膽管損傷、出血、膽囊管殘余結石病例的發生，2例出現膽瘺，經引流后治愈。結論嚴格規范的操作,良好顯露膽囊三角,辨清肝總管、膽總管和膽囊管之間的關系,是正確處理膽囊管結石的關鍵。

膽囊結石、膽囊切除術與大腸癌關系的臨床研究

Cause , Management and Prevention of Un-Typical Biliary Fistula af ter Laparoscopic Cholecystectomy

【 Abstract 】 Objective To investigate the cause, management and prevention of biliary fistula with un-typical after laparoscopic cholecystectomy (LC). Methods Twenty-one cases of biliary fistula with un-typical after LC were reviewed retrospectively. Results All patients displayed with un-typical expression and had no obvious signs of peritonitis. Lump of right upper quadrant (6 cases) ， vague pain of epigastric zone (11 cases) ， abdominal distention (3 cases) and bowel obstruction (1 case) after operation were main manifestations. Abdominal paracentesis (14 cases) ， bile exuded from incisional opening of trocar (6 cases) and exploratory laparotomy (1 caes) were the methods of final diagnosis. The cause of biliary fistula included cystic stump fistula (2 cases) ， aberrant bile-duct fistula (9 cases) ， and accessory hepatic duct fistula (4 cases). Laparoscopic approach and puncturation and drainage under ultrasound were the main therapeutic methods. All patiens were discharged successfully with no death case. Nineteen cases were followed up for 3 months to 2 years, and all patients recovered very well. Conclusion The biliary fistula with un-typical after LC is scarce ， and it can lead to missed diagnosis and treatment. Strengthening recognition of biliary fistula after LC ， and paying attention to chief complaint and abdominal sign can help discover biliary fistula early. Laparoscopic approach and puncturation under ultrasound are the recommended therapeutic methods.