腹腔镜胆囊切除致胆道损伤30例回顾

Retrospective study of causes-type and treatment of bile duct injury due to laparoscocpic cholecystecomy in 30 cases

目的总结腹腔镜胆囊切除(Laparoscocpiccholecystecomy,LC)致胆道损伤(Bileductinjury,BDI)的经验教训。方法对1992-12～2002-12因腹腔镜胆囊切除致胆道损伤30例患者有关资料进行回顾性分析。结果所有患者最终均需剖腹手术治疗。手术方式根据损伤部位、类型、损伤后发现的时间决定。随访率为93.33%(28/32),随访时间1～10年。优良率86.67%。结论解剖变异、病理变化、术者的责任心和技术因素是LC致BDI的重要原因。术中发现即行对端吻合或修复+T管引流,术后数天发现或多次重建失败者,最宜行规范的胆肠Roux-en-Y吻合术。

Objective To summanize the experience and lesson drawn from BDI due to LC. Methods The 30 patients were studied restrospectively from December- 1992 to December- 2002. Results All the patients were treated ultimately by operation. The method of treatment was according to the type of deposit- site and the time after injury; 93.33%(28/30) of the patients were followed up from one to ten years- effects of treatment in 86.67% of patients were satisfactory. Conclusion The main cause is lack understanding of the anatomy variety and pathological change- and responsibility and experience or skill of the operator during operation. To manage patient immeadiately by end-to-end anastomosis of the bile duct or repair with T tube prosthesis during surgery is reliable. For patient whose treatment had be delayed for several days or reconstruction surgery was failed- the Roux-en-Y hepaticojejunostomy is an efficient method.