【Abstract】Objective To investigate prophylactic measures for nontraumatic complications of laparoscopic cholecystectomy (LC).Methods The data of 13 000 patients who underwent LC in Kunming general hospital of PLA over 13 years(1991-2004) were retrospectively reviewed. Results Nine malignant tumors and 47 common bile duct stones were missed at LC. The 9 malignant tumors included hepatic cancer (n=1), gastric cancer (n=1), gallbladder cancer (n=2), pancreatic cancer (n=2) and right colon cancer (n=3). Of all the carcinomas, 3 patients with right colon cancer underwent colectomy, the other 6 patients couldn’t be cured radically. All the 47 patients with choledocholithiasis were cured successfully, among them 31 patients were performed with ERCP and 16 were reoperated on with cholangiotomy. Conclusion This study emphasizes the necessity to analyze carefully patients’ symptoms before operation and pay attention to pathological changes of gallbladder and intraabdominal situation intraoperatively. If necessary, laparoscopic ultrosonography can be used to avoid missing malignant tumors and biliary stones.
Citation：
ZHANG Jixiang,CHEN Xunru,LUO Ding,MAO Jingxi,ZHOU Zhengdong,YU Shaoming,LI Shenghong,LIU Cheng,HAN Jiang,LI Linhai,WANG Hongguang,JIN Yun,QING Deke,CHEN Gang.. Prophylactic Measures for Non
Traumatic Complications of Laparoscopic Cholecystectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2005, 12(6): 558-560. doi:
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张吉祥，陈训如，罗丁. 腹腔镜胆囊切除术中胆道外腹腔内病变遗漏的防范 [Ｊ]. 中国微创外科杂志， 2004； 4（1） 812 陈训如，田伏洲，黄大熔主编. 微创胆道外科手术学 [M].第1版.北京： 军事医学科学出版社， 2000117~1183 Kingham JG, Dawson AM. Origin of chronic right upper quadrant pain [Ｊ]. Gut, 1985; 26(8)7834 Soper NJ, Stockmann PT, Dunnegan DL, et al. Laparoscopic cholecystectomy. The new ‘gold standard’? [Ｊ]. Arch Surg, 1992; 127(8)9175 Shirai Y, Yoshida K, Tsukada K, et al. Inapparent carcinoma of the gallbladder. An appraisal of a radical second operation after simple cholecystectomy [Ｊ]. Ann Surg, 1992; 215(4)3266 Paolucci V, Schaeff B, Schneider M, et al. Tumor seeding following laparoscopy: international survey [Ｊ]. World J Surg, 1999; 23(10)9897 刘国礼. 我国腹腔镜外科的现状——156 820例腹腔镜手术综合报告 [Ｊ]. 中华普通外科杂志， 2001； 16（9）5628 Berdah SV, Orsoni P, Bege T, et al. Followup of selective endoscopic ultrasonography and/or endoscopic retrograde cholangiography prior to laparoscopic cholecystectomy: a prospective study of 300 patients [Ｊ]. Endoscopy, 2001; 33(3)2169 田伯乐，张肇达，胡伟明，等. 无症状性胆总管结石的诊治经验 [Ｊ]. 肝胆外科杂志， 1999； 7（4）27310 王宏光，陈训如. LC与胆总管结石的治疗策略 [Ｊ]. 中华肝胆外科杂志， 2004； 10（2）14211 张吉祥，陈训如，罗丁. 腹腔镜胆囊切除术立即中转开腹37例分析 [Ｊ]. 临床外科杂志， 2004； 12（6）38012 罗丁著. 腹腔镜超声诊断学 [M]. 第1版. 北京： 军事医学科学出版社， 200349~5113 李胜宏，陈训如，罗丁，等. 腹腔镜胆囊切除术残留胆管结石的防治 [Ｊ]. 中华临床医学杂志， 2003； 4（21）5514 Ammori BJ, Birbas K, Davides D, et al. Routine vs “on demand” postoperative ERCP for small bile duct calculi detected at intraoperative cholangiography. Clinical evaluation and cost analysis [Ｊ]. Surg Endosc, 2000; 14(12)1123.
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张吉祥，陈训如，罗丁. 腹腔镜胆囊切除术中胆道外腹腔内病变遗漏的防范 [Ｊ]. 中国微创外科杂志， 2004； 4（1） 812 陈训如，田伏洲，黄大熔主编. 微创胆道外科手术学 [M].第1版.北京： 军事医学科学出版社， 2000117~1183 Kingham JG, Dawson AM. Origin of chronic right upper quadrant pain [Ｊ]. Gut, 1985; 26(8)7834 Soper NJ, Stockmann PT, Dunnegan DL, et al. Laparoscopic cholecystectomy. The new ‘gold standard’? [Ｊ]. Arch Surg, 1992; 127(8)9175 Shirai Y, Yoshida K, Tsukada K, et al. Inapparent carcinoma of the gallbladder. An appraisal of a radical second operation after simple cholecystectomy [Ｊ]. Ann Surg, 1992; 215(4)3266 Paolucci V, Schaeff B, Schneider M, et al. Tumor seeding following laparoscopy: international survey [Ｊ]. World J Surg, 1999; 23(10)9897 刘国礼. 我国腹腔镜外科的现状——156 820例腹腔镜手术综合报告 [Ｊ]. 中华普通外科杂志， 2001； 16（9）5628 Berdah SV, Orsoni P, Bege T, et al. Followup of selective endoscopic ultrasonography and/or endoscopic retrograde cholangiography prior to laparoscopic cholecystectomy: a prospective study of 300 patients [Ｊ]. Endoscopy, 2001; 33(3)2169 田伯乐，张肇达，胡伟明，等. 无症状性胆总管结石的诊治经验 [Ｊ]. 肝胆外科杂志， 1999； 7（4）27310 王宏光，陈训如. LC与胆总管结石的治疗策略 [Ｊ]. 中华肝胆外科杂志， 2004； 10（2）14211 张吉祥，陈训如，罗丁. 腹腔镜胆囊切除术立即中转开腹37例分析 [Ｊ]. 临床外科杂志， 2004； 12（6）38012 罗丁著. 腹腔镜超声诊断学 [M]. 第1版. 北京： 军事医学科学出版社， 200349~5113 李胜宏，陈训如，罗丁，等. 腹腔镜胆囊切除术残留胆管结石的防治 [Ｊ]. 中华临床医学杂志， 2003； 4（21）5514 Ammori BJ, Birbas K, Davides D, et al. Routine vs “on demand” postoperative ERCP for small bile duct calculi detected at intraoperative cholangiography. Clinical evaluation and cost analysis [Ｊ]. Surg Endosc, 2000; 14(12)1123.
