腹腔镜胆囊切除致胆管损伤的教训和预防体会

Prevention of bile duct injury during laparoscopic cholecystectomy

目的加强胆管损伤的防范意识,加强对胆囊解剖变异变化多等特点的认识,不断提高腹腔镜操作技术,尽量减少和避免腹腔镜胆囊切除术中胆管损伤的发生。方法回顾总结分析我院1998年5月至2005年12月经腹腔镜胆囊切除术572例,结果共造成胆管损伤5例,其中胆总管横断3例(其中1例伴肝总管横断)、肝总管损伤1例,右肝管损伤1例。结论在术中仔细辨认胆囊管,尽量能看到肝总管以确定三管(胆囊管、胆总管、肝总管)的关系,要仔细分离解剖胆囊内三角(Calot)。

Objective To minimize bile duct injury during laparoscopic cholecystectomy, Methods Data of 572 patients undergoing laparoseopic choleeystectomy from May 1998 to December 2005 were retrospectively analysed, Results Bile duct injury occurred in 5 patients. Of which, there were common bile duct transection in 3 patients（ 1 patient also had common hepatic duct transaction）. Common hepatic duct injury in 1 patient, right hepatic duct injury in 1 patient, Conclusion The cystic duct should be carefully identified during surgery, Try to find out the common hepatic duct in order to determine the relationship among cystic duct, common bile duct and common hepatic duct. The gallbladder Calot g triangle should be separated carefully.