腹腔镜胆囊切除术致胆管损伤17例分析

The analysis of 17 cases with bile duct injuries caused by laparoscopic cholecystectomy

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)致胆管损伤的原因及处理方法。方法:回顾分析LC致胆管损伤17例患者的临床资料(11例胆总管损伤,4例肝总管损伤,2例右肝管损伤),并分析其原因及处理方法。结果:20000例LC中发生胆管损伤17例,占0.085%(17/20000),胆管损伤的主要原因是解剖变异,周围组织粘连,局部充血水肿。主要行胆肠Roux-en-Y吻合,T管支撑引流,尿管支撑引流并直接吻合瘘口等。17例胆管损伤患者经过上述处理后均痊愈出院,随访半年以上,恢复良好。结论:胆管损伤是LC术中严重且常见的并发症,掌握胆囊三角的解剖技巧,处理好胆囊管、胆囊动脉是减少胆管损伤的关键。对解剖异常,粘连严重,局部充血水肿的患者应给予高度重视,一旦发现胆管损伤及时中转开腹,经过及时有效的处理,可避免严重后果。

Objective ：To explore the causes and treatment of bile duct injuries caused by laparoscopic cholecystectomy （LC）. Methods：The clinical data of 17 cases with bile duct injuries caused by laparoscopic cholecystectomy was analysed retrospectively including eleven cases with common bile duct injuries, four with common hepatic duct injuries,two with of right hepatic duct injuries. Resuits：Seventeen cases with bile duct injuries occurred in 20 000 eaese of LC, main treatments included choledochojejunostomy T-tube or catheter drainage, and direct anastomosis. All the cases with bile duct injuries were cured and had a good recovery with a follow up of more than half a year. Conclusions ： Bile duct injuries are severe and the most common complication of LC. The dissection of calot＇s triangle, the isolation of cystic duct and artery are key steps to avoid bile duct injuries. Patients with anormal anatomy, severe adherion and localized edema should be attached much importance. Timely conversion to open surgery and effective treatment can avoid severe consegences.