探讨腹腔镜术后严重并发症的发生原因及处理。

回顾性分析2008年1月至2013年1月在深圳市第三人民医院接受诊治的7例腹腔镜术后严重并发症患者临床资料。所有患者均签署知情同意书，符合医学伦理学规定。其中男3例，女4例；年龄6～67岁，中位年龄40岁。收集患者诊治经过等临床资料，总结并发症发生的原因、处理和预防措施。

5例行腹腔镜下胆囊切除术患者中，4例因腹腔粘连较重、胆囊三角解剖不清导致胆管损伤，另1例因行剑突下穿刺孔时将肝镰状韧带刺破而导致术后发生绞窄性肠梗阻。1例行腹腔镜下腹股沟斜疝疝囊高位结扎术，因部分小肠通过脐下方穿刺孔进入腹膜外，术后发生绞窄性肠梗阻。1例行腹腔镜下腹股沟斜疝无张力修补术，术中可能因牵拉组织使睾丸扭转而致左侧睾丸缺血坏死。4例胆管损伤患者先行一期置管引流术，其中3例因胆道严重狭窄行二期胆管-空肠Roux-en-Y吻合术，术后恢复良好；另1例术后3个月行内镜下胆道支架植入术。2例绞窄性肠梗阻患者急诊行小肠部分切除+端端吻合术，术后恢复良好。1例睾丸坏死患者行睾丸切除术。

腹腔镜术后发生严重并发症的主要原因可能是局部解剖不清楚、未及时更改手术方式等。早期发现、全面评估、实施合理的外科治疗是改善此类患者预后的重要措施。

To investigate the causes and treatments of severe complications after laparoscopic surgery.

Clinical data of 7 cases with severe complications after laparoscopic surgery in the Third People’s Hospital of Shenzhen from January 2008 to January 2013 were analyzed retrospectively. The informed consents of all patients were obtained and local ethical committee approval had been received. There were 3 males and 4 females with the age ranging from 6 to 67 years old and median of 40 years old. The diagnosis, treatments clinical data of the patients were collected, and the causes, treatments and prevention measures of the complications were summarized.

Five cases underwent laparoscopic cholesystectomy (LC), 4 of which suffered bile duct injury for severe abdominal adhesion and unclear anatomy of the Calot triangle and 1 case suffered strangulated intestinal obstruction after operation because the hepatic falciform ligament was ruptured when puncturing below the xiphoid. One case underwent laparoscopic high ligation of hernial sac for indirect inguinal hernia and suffered strangulated intestinal obstruction after operation because part of the small intestine ran out of the peritoneum through the port site below the umbilicus. One case underwent laparoscopic tension-free repair for indirect inguinal hernia and suffered ischemic necrosis of the left testis possibly because of testicular torsion when stretching the tissue. The 4 cases with bile duct injury received primary drainage, 3 of which underwent secondary Roux-en-Y cholangiojejunostomy for severe biliary stricture and all recovered well after operation, and the other case underwent endoscopic biliary stent implantation 3 months after operation. The 2 cases with strangulated intestinal obstruction underwent emergent partial resection and end-to-end anastomosis of small intestine and recovered well after operation. The case with necrosis of testis underwent testicular excision.

The main causes of severe complications after laparoscopic surgery probably are the unclear local anatomy and failing to convert surgical procedure timely, etc. Early diagnosis, comprehensive evaluation and proper surgical interventions are the important measures for improving the prognosis of these patients.