腹腔镜胆囊切除术胆管损伤的原因及处理

The reason and the treatment for the bile duct injury in laparoscopic cholecystectomy

目的探讨腹腔镜胆囊切除术（LC）中胆管损伤（Bile duct injury，BDI）原因及处理方法。方法1996年至2007年2854例腹腔镜胆囊切除术（LC）中11例胆管损伤的原因，损伤的部位进行探讨。其中解剖病理因素7例，操作因素4例。损伤部位：胆总管6例，肝总管4例，右肝管1例。结果9例经中转开腹8例行胆管修补加T管支撑。1例行胆总管空肠吻合术加支撑。LC术后因出现胆汁性腹膜炎再手术发现胆管损伤2例，其中胆总管及肝总管损伤各1例。1例行胆管修补加T管支撑。1例行胆管端端吻合术加T管支撑。结论掌握好中转开腹时机是避免LC胆管损伤的重要环节。

Objective Summary Purpose To discuss the reason and the methods of treatment for the Bile duct injury（BDI） in laparoscopic cholecysteetomy（LC）. Methods To explore the reasons and the places for 11 BDI cases of 2854 which operated between 1996 and 2007. It was found that the numbers for anatomy reasons and operation reasons were respectively 7 and 4. Besides, the places for injury are, namely,6 eholedoehus injuries,4 hepatic duct injuries and 1 right hepatic duct injury. Results 9 cases had been using open cholecysteetomy and 8 cases for bile duct repairing which were supported by T channel. Only one case was operated by cholangiojejunstomy. There were 2 cases which caused by re-operated and one for eholeperitionitis. There have been repairing for other 2 cases and T channel were supported for choledochus injury and hepatic duct injury. Conclusion Well handling the open eholecysteetomy is the turning point of avoiding LC bile duct Injury.