腹腔镜胆囊切除致胆管损伤的原因分析及处理体会

Analysis and Treatment for Bile Duct Injury（BDI） in Laparoscopic Cholecystectomy （LC）

目的探讨腹腔镜胆囊切除术（LC）中胆道损伤（BDI）的原因，寻求BDI的处理方法。方法回顾分析1997年7月-2007年12月共行腹腔镜胆囊切除术2126例，其中5例发生BDI，发生率为0，23％。探讨BDI发生的原因、损伤类型、处理方法及预后。结果根据不同类型及损伤程度分别给予损伤胆总管端端吻合术或胆道-空肠Roux—en—Y吻合术及行胆总管“T”管引流术。术后恢复良好。结论减少LC胆管损伤的关键在于预防。腹腔镜手术者应具备操作技巧熟练、胆管解剖清晰和及时中转开腹的理念。一旦发生胆管损伤，及时正确的处理可以减少患者的远期并发症，使腹腔镜手术的优势得到充分发挥。

Objective To approach the causes of BDI in LC, to seek the methods in treatment of BDI. Methods Retrospective analyse 2126 cases of LC between July,1997 and December,2007. There are 5 cases of BDI in totally statistical LC cases, the incidence rate is 0.23%. According to these, we discuss the causes, types, treatment methods and prognosis of BDI. Results According to the different types and degree of injury, we perform the choledochocholedochostomy, biliary - jejunum Roux - en - Y anastomosis and choledochus ＂T＂ tube drain respectively. Postoperative recovery are good. Conclusion The key to reduce the BDI in LC is to PREVENT in advanced. The operator of LC should be experienced, grasp the anatomy of bile duct and have the idea of transferring to normal operation promptly. Once BDI occurs, the proper treatment in time is important. It can reduce the long - term complications of LC. The advantages of LC can be fully utilized.