腹腔镜胆囊切除术的胆管并发症与防治

BILIARY COMPLICATIONS AND PREVENTION DURING LAPAROSCOPIC CHOLECYSTECTOMY

该文报告腹腔镜胆囊切除术中的胆管并发症13例，10例胆管损伤，其中胆床部小胆管漏5例，肝外胆管侧壁伤1例，副胆管漏伴肝管侧壁伤1例，主胆管钳闭或横断3例。上述10例中，1例因胆汁性腹膜炎伴ARDS死亡，余9例治愈，随访1～2年，未见有胆管狭窄。另3例中，胆囊管残端漏1例，胆囊管残端结石存留2例。并对产生并发症可能的原因，它们的预防和处理进行了讨论。

Thirteen laparoscopic cholecystectomy patients with biliary complications were studied over a two year period.Ten of the 13 patients' complications could be attributed to biliary injury, including five bile leaks from a minor ductin the liver, one lateral injury to the extrahepatic bile duct, one accessory bile duct leak with lateral injury to the hep-atic duct, and three clip ligations and diyisions of a major bile duct. Of the ten patients, one died uf bile peritonitisassociated with an ARDS, while the rest of the patients recovered with no stenosis in the bile duct after a follow upperiod of one to two years. In the remaining three patients, there were two ocurrences of stones being retained in thecystic duct of the stump, and one cystic duct leak as a result of clip occlusion failure. The possible mechanisms, pre-vention and management of biliary complications were discussed.