单纯胆囊切除术中胆管损伤的防治体会

Experience in the prevention and management of biliary tract injury complicated by simple cholecystectomy

为减少胆囊切除手术的并发症,作者复习了近十年来1875例单纯胆囊切除术中9例胆管损伤的情况(其中5例由外院转入),胆管损伤的发生率为0.48%。9例胆管损伤中,5例系胆管完全横断,损伤超过管壁直径50%的2例,不足50%的1例,完全缝扎伤1例。术中发现胆管损伤者3例,当即行胆道重建手术。其中1例行胆总管端端吻合术,1例行肝总管修补术,1例行肝总管十二指肠端侧吻合术。6例未及时发现胆管损伤者,4例行胆管空肠 Roux-en-Y 式吻合术,1例因胆总管被缝扎,剪除缝扎线后放置 T 管支撑引流,1例因胆总管未完全离断行胆总管端端吻合术。胆囊切除术的关键在于术者对局部解剖的辨认和对肝门处胆管解剖变异的识别能力。

In order to reduce surgical complications of cholecystec- tomy,we reviewed the 9 patients of accidntal injuries to the bile duct during 1875 open cholecystectomies (5 pa- tients were referred from other hospitals).The total in- cidence for bile tract injury was 0.48%.Complete tran- section occurred in 5 patients,transection for more than 50% of the circumference in 2,transection for less than 50% in 1,and complete ligation in 1.Three injuries were found immediately during the cholecystectomy,and treated by primary bile ducy reconstruction.The remain- ing 6 injuries were found postoperatively;4 patients re- ceived reconstruction with Roux-en-Y choledocho-je- junostomy,T tube stent was placed in 1 patient with common bile duct accidently sutured,and end-to-end choledochostomy was performed in 1 with incomplete di- vision of the bile duct.Our experiences demonstrated that safe and successful surgery of the bile duct requires comprehensive understanding the topography,and varia- tion of the bile duct.