腹腔镜胆囊切除术中胆道损伤的预防和处理

Prevention and Treatment of Bile Duct Injuries in Laparoscopic Cholecystectomy

目的探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)致胆道损伤的原因、预防措施和处理方法。方法对7例LC引起的胆道损伤病例进行回顾性分析。结果7例胆道损伤病例中,术中钛夹误夹闭胆总管1例;3例Mirizzi综合征致胆总管损伤;右肝管损伤2例,其中1例是由于胆囊管变异所致;1例因胆囊颈部粘连严重,分离中在肝门处断离左肝管,并损伤右肝管。所有病例均行胆总管修补或端端吻合术,T管引流获得成功。结论LC引发的胆道损伤应引起足够的重视。发现不及时或处理不当都可能引起严重并发症。术者经验、局部粘连严重和胆道变异是胆道损伤的主要原因。可采用胆总管修补成形、端端吻合术或胆总管空肠Roux-en-Y吻合术治疗胆道损伤。

Objective To discuss the cause of bile duct injuries caused by laparoscopic cholecystectomy （LC） and their prevention and treatment. Methods Review was done on seven patients of bile duct injury because of LC. Results In the 7 cases, bile duct injuries resulted from mistakenly clamping of common bile duct with titanium clamp in 1 case, Mirizzi syndrome in 3 cases, right liver duct injury in 2 cases, gallbladder duct aberrance in 1 cases, and gallbladder neck＇ s sever conglutination 1 case （ fight and left liver ducts injury due to the operation of separation）. All the patients were dealed with the common bile duct＇ s repair or anastomosis and T pipe drainage. Conclusion We should put importance on the bile duct injuries in LC. They may result in severe complications if not found or dealed with in time. Inexperience of operators, sever local conglutination and bile duct aberrance are the chief causes of injuries. The chief approaches to the treatment of bile duct injuries consist of the common bile duct＇ s repair or anastomosis and T pipe＇ s drainage or the common bile duct and Jejunum anastomosis.