腹腔镜胆囊切除术胆管损伤46例报告

Bile duct injuries during laparoscopic cholecystectomy: Report of 46 cases

目的探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）中减少或避免胆管损伤的术中判断和操作技巧。方法回顾分析我院1992年10月～2005年10月39860例LC的临床资料，其中胆管损伤46例。结果行胆管裂口修补，置T管支撑引流26例；游离两断端，做端端吻合，T管支撑引流4例。T管支撑时间3～12个月。胆管空肠的Rouxen-Y吻合11例；副肝管结扎5例。胆管狭窄再手术4例，胆肠吻合口狭窄再手术2例。结论深刻的解剖认识，熟练的操作技巧可以避免或减少胆管损伤的发生。早期诊断和处理胆管损伤避免急性炎症期是防止多次胆道手术的重要举措。

Objective To discuss how to improve judgement and technique for avoiding bile duct injury during laparoscopic cholecystectomy （LC）. Methods The clinical data of 39 860 patients treated by LC between October 1992 and October 2005 were analyzed retrospectively. Bile duct injury occured in 46 patients. Results Bile duct repair and T-tube drainage was performed in 26 patients and bile duct end-to-end anastomosis and T-tube drainage was performed in 4 patients, with the T-tube indwelling time for 3～12 months. The Roux-en-Y cholangiojejunostomy was conducted in 11 patients, the ligation of accessory hepatic duct was conducted in 5 patients, the re-operation for bile duct stenosis in 4 patients, and the re-operation for stenosis after cholangiojejunostomy, in 2 patients. Conclusions Intensive anatomic knowledge and skillful surgical performance can avoid or minimize the incidence of bile duct injury. Early detection and active repair of the bile duct injury for preventing acute inflammation is the most important measure to avoid repeated operations.