腹腔镜胆囊切除术中肝外胆道损伤的控制与预防

Controlling and preventing measures of lesions of extrahepatic biliary tract in laparoscopic cholecystectomy

目的总结腹腔镜胆囊切除术中肝外胆道损伤的有效控制与预防措施。方法回顾性分析2000年1月至2006年12月本院行腹腔镜胆囊切除术的897例患者的完整资料,并对控制和预防肝外胆道损伤的效果进行分析。结果本研究中897例行腹腔镜胆囊切除术的患者中,早期进行的205例中有23例发生肝外胆管损伤,3例中转开腹;而2002年3月之后进行的692例无一发生肝外胆管损伤,也没有中转开腹。结论腹腔镜胆囊切除术中应熟悉胆囊管、胆囊颈的生理结构,根据胆囊的具体情况选择不同的手术方法,通过经验的累积可以减少腹腔镜胆囊切除术中肝外胆道损伤。

Objective To summary the effectively controlling and preventing measures of lesions of extrahepatic biliary tract in laparoscopic cholecystectomy. Methods The data of 897 cases with laparoscopic cholecystectomy were analyzed retrospectively, and we evaluated the effects of controlling and preventing measures of lesions of extrahepatic biliary tract in Tongxiang Traditional Chinese Medical Hospital. Results In total 897 cases,23 patients had lesions of extrahepatic biliary tract in laparoscopic cholecystectomy and 3 patients did general cholecystectomy in 205 cases from Jan 2001 to Feb 2002. But no case had lesions of extrahepatic biliary tract in laparoscopic cholecystectomy or did general cholecystectomy in 692 cases from Mar. 2003 to Dec. 2006. Conclusion Physiological constructions of cystic duct and neck of gallbladder must be comprehended in laparoscopic cholecystectomy, and to choose method of laparoscopic cholecystectomy according the satatus of gallbladder. Lesions of extrahepatic biliary tract in laparoscopic cholecystectomy could be decreased by experience accumulation.