腹腔镜胆囊切除术中胆管损伤及对策

Biliary ducts injury and prophylaxis treatment in laparoscopic cholecystectomy

目的:探讨腹腔镜胆囊切除术中胆管损伤的原因及预防措施。方法:回顾分析4929例腹腔镜胆囊切除术中17例胆管损伤的原因,治疗及预防方法。结果:术者对腹腔镜胆囊切除术的危险缺乏认识、缺乏经验及应变力、不能辩认异常,过于自信,操作粗糙及使用器械不当是发生损伤的根本原因。结论:重视正规训练,积累并借鉴成功的传统手术经验、技巧。分离解剖应从明确的胆囊或与胆囊管交界部开始,不刻意解剖,明确三管关系,禁止在Calot三角内电灼是预防损伤的关键。对可能或已发生的损伤应予以合理处理,以免病情复杂化。

Objective :To explore the cause of biliary ducts injury and prophylaxis treatment in laparoscopic cholecystectomy (LC) .Methods:The cause, treatment and prophylaxis treatment of 17 cases with biliary ducts injury from 4929 LC were retrospectively analysed. Results: Lacking knowledge of the dangerous. experience and flexibility , being unable to discern the abnormality and too confidence, unaccurately operating and unsuitable use of instrument were the main causes. Conclusion: Paying attention to regular training, learning from traditonal operation experience, dissecting from difinite gallbladder or the borderline of cystic duct and contraindicating electroexcison in calot triangle are the key points of preventing trauma. Coping with the trauma which maybe or have happened carefully and suitably can avoid perplexity of the disease and treament.