المضاعفات الباكرة لاستئصال المرارة بالتنظير والطريق المفتوح
Abstract
شملت الدراسة 267 مريضا قبلوا في مستشفى الأسد الجامعي باللاذقية من 1\1\2006 وحتى 1\10\2010 خضعوا جميعا لاستئصال مرارة كانت نسبة الذكور 29.2% والإناث 70.8% , وتراوحت أعمار المرضى
بين 15 و80 سنة, تم القبول بشكل إسعافي عند 18.4% وبشكل مبرمج عند 81.6% . تم تقسيم المرضى إلى ثلاث مجموعات: المجموعة الأولى: المرضى الذين خضعوا لاستئصال مرارة بالطريقة المفتوحة 117 مريضا (43.9%) , المجموعة الثانية: مرضى استئصال بالمنظار 134مريضا (50.2%), المجموعة الثالثة: تم فيها التحويل من التنظير إلى الجراحة المفتوحة 16 مريضاً (5.9%). شملت المضاعفات بعد العمل الجراحي حصيات قناة الصفراء المنسية, التهاب معثكلة, حالتي اندحاق في جرح العملية بعد أسبوعين من العمل الجراحي, نزف من السرير المراري, حالات من ناسور صفراوي, حالة من تحت انسداد أمعاء بسبب انحشار جزء من جدار الأمعاء في ثقب السرة التنظيري, وفاة وحيدة. نسبة المضاعفات كانت أكبر عند مرضى المجموعة الثالثة (التحويل) حيث بلغت 18.7% ، تليها النسبة في المجموعة الأولى (الجراحة المفتوحة) 11.1 % ثم مرضى المجموعة الثانية (التنظير) 6.7%. لوحظ أن مرضى المجموعة الأكثر مضاعفات (مجموعة التحويل) أغلبهم من الذكور، ذوي الزيادة في نسبة الأمراض المرافقة عندهم، إضافة للتقدم في العمر؛ إذ العمر الوسطي (58سنة). لم يلاحظ دور للعمل الجراحي- في القبول الإسعافي- في زيادة معدل المضاعفات.
This study includes 267 patients admitted to the department of surgery in al-Assad University Hospital at Lattakia, between 1/1/2006 and 1/10/2010. They all had cholecystectomy due to cholecystolithiasis, acute cholecsystitits, or gallbladder polyps (3%). The male patients composed 29.2%, and the female patients composed 70.8% of the study population, the age of the patients was between 15 and 80 years old. The admission was either emergent (18.6%) or elective (81.6%). Patients were divided to three groups:
1- Patients with open cholecystectomy, 117 patients(43.9%),
2- Patients with laparoscopic cholecystectomy, 134 (50.2%), and
3- Conversion from laparoscopic cholecystectomy into open cholecystectomy 16 patients (5.9%).
Post surgical complications included: cases of collecting duct stones, cases of pancreatitis, and 2 cases of wound eventration 2 weeks after the surgery, cases of bleeding from gallbladder hilus, cases of biliary fistula, one case of subtotal intestinal obstruction due to impaction of part of the intestinal wall in laparoscopic wound, and one case of death. Complication ratio was higher in patients from the third group (conversion group), which was 18.7%, then we had complications in the first group (open cholecystectomy group) which was 11.1%; then, patients from the second group (laparoscopic cholecystectomy) had the lowest complications ratio which was 6.7%. We found that patients from the higher complication group (conversion group) were males, advanced age (mean age of 58) with comorbidities. No role of emergent surgical procedure in increasing complications was noted.
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