腹腔镜胆囊切除术致胆管损伤一期修补的临床分析

Clinical study on primary repair for bile duct injury during laparoscopic cholecystectomy

目的探讨腹腔镜胆囊切除术致胆管损伤一期修补的可行性、手术方式及临床效果。方法回顾总结我院1994至2004十年间腹腔镜胆囊切除14302例中,致胆管损伤53例的损伤特点,并对17例胆管损伤行一期修补的适应证、修补方法及其结果进行了研究分析。结果本组53例胆管损伤,术中发现的42例,33例为胆(肝)总管及右肝管撕裂伤。其中17例行一期修补,7例一期修补后置腹腔引流管,10例一期修补后经胆囊管胆道减压。17例均顺利恢复,于术后6h下床活动,24h恢复胃肠蠕动,平均住院时间为4·6d。16例得到随访,无胆管狭窄。结论腹腔镜胆囊切除术致胆管损伤与开腹胆囊切除致胆管损伤比较有其特点,选择合适的病例行一期修补是安全有效的。

Objective To evaluate the place of primary repair of bile duct injury during laparoscopic cholecystectomy(LC). Methods Between 1994 and 2004, 53 of a total 14 302 cases were identified with bile duct injury.The indication, methods and outcome of primary repair for 17 cases of bile duct injury were analyzed.Results Forty-Two of 53 cases of bile duct injury were identified at the time of operation, thirty three involved a tear of the common , hepatic or right hepatic bile duct,and 17 cases received primary repair .Drainage tubes were placed in 7 cases ,and biliary drainage through the cystic duct was performed in 10 cases.All patients recovered well and got out of bed within 6 hours postoperatively.The alimentary tract recovered in 24 hours after operation in all cases, and their mean hospitalization was 4.6 days.Sixteen patients were followed up, and no stricture of bile duct was found.Conclusion Repair of bile duct injury during LC is safe and effective in selected cases.