腹腔镜胆囊切除术中围肝门部管道少见变异的处理

The rare variation of porta hepatic ducts with video laparoscopic cholecystectomy

目的研究腹腔镜胆囊切除术(LC)中围肝门部少见胆道和血管解剖变异及胆管和血管损伤的防治。方法1992-2006年,南方医科大学珠江医院在LC中对5例围肝门部管道少见变异进行了解剖及处理。均在气管插管全麻下,人工CO2气腹,采用“三管一孔一脏器”的显露方法,解剖围肝门部管道及胆囊切除。结果右肝管、肝右动脉及胆囊动脉变异1例,双胆囊管1例,变异的胆囊动脉及病理的胆囊管1例,异常的胆囊动脉和胆囊管合并迷走胆管1例,胆总管、肝总管、门静脉异常1例,均成功进行了胆囊切除手术,未发生血管及胆管损伤。结论应加强LC术中对异常胆道变异的认识和处理水平,对减少并发症具有非常重要的意义。

Objective To research the rare variation of the biliary tracts and the blood vessels dissection around the porta hepatic ducts, to prevent the injury of the biliary tracts and the blood vessels and improve the quality of LC. Methods 5 patients who have the rare variation of porta hepatic ducts were operated with laparoscopic hepatectomy. Under general anesthesia and carbon dioxide pneumoperitoneum, three-duct, one-hole and one-organ （TOO） was used to dissect the structure around the porta hepatic ducts in LC which was revealed through anatomizing lateral back of Calot＇ s triangle. Results All the cases were operated with cholecystectomy successfully ： a case variant of the right hepatic duct, right he- patic artery and arteria cystica, a case variant of double cystic duct, a case variant of arteria cystica with pathologic bile duct, a case variant of arteria cystica with Variant cystic duct and variant bile duct, and a case variant of common bile duct and portal vein. Conclusion The level of understanding and dealing the rare variation of biliary tracts and the blood vessels in LC is very important for improving the surgery quality and reducing the illness complications