腹腔镜胆囊切除术导致胆管损伤的外科治疗

Surgical Management of Bile Duct Injuries Induced by Laparoscopic Cholecystectomy

目的探讨腹腔镜胆囊切除术(LC)所致胆管损伤的外科治疗方法及疗效。方法回顾性分析1992年1月～2005年12月间我院收治的LC导致胆管损伤的37例病人的临床资料,并结合随访结果进行分析总结。结果37例病人中15例胆管损伤在我院发生,22例为外院发生。胆管修补(或端端吻合)+T管支撑引流术5例(13.5%),胆管空肠Roux-en-Y吻合术29例(78.4%),经B超引导腹腔穿刺置管引流1例(2.7%),长期保留LC术中所置腹腔引流管2例(5.4%)。术后无死亡病例,10例(27%)病人出现至少一个手术后并发症,其中包括切口感染5例(16.2%),吻合口狭窄3例(8.1%),腹腔脓肿5例(16.2%),手术后均经气囊扩张或经皮穿刺置管引流后好转,没有病人需要再次手术治疗,远期随访有效率为100%。结论胆管损伤是腹腔镜胆囊切除术中常见的严重并发症,采用恰当的外科治疗方法可获得较好的疗效。

Objective To investigate the methods and effects of surgical management in patients with bile duct injuries （BDI） induced by laparoscopic cholecystectomy（LC）. Methods Clinic data of 37 hospitalized patients with BDI induced by LC during January 1992 to December 2005 were analyzed retrospectively. Results Among 37 patients（ 15 of them occurred from our hospital and 22 of them from outside）. Bile duct repalring（end-to-end anastomosis） ＋ T-shape tube support and drainage opera- tion was performed in 5 cases （ 13.5% ）, Roux-en-Y cholangioje junostnmy was performed in 29 cases （78.4%）, percutaneous abdominal drainage guided by B-ultrasoud was performed in 1 case（2. 7% ） and long-term retaining abdominal drainage after LC was performed in 2 cases（5.4% ）. After operation, none of patients died, but 10 of them suffered from at least one or two compli- cations, these included incisional wound infection （ 13.5 % ）, anastomotic stricture （ 8. 1% ）, abdominal absess （ 13.5 % ）. All patients with complications recovered by balloon dilation or pereutaneous abdominal drainage after operation, none of them needed another operation in solving those complications,and long-term effective rate was 100 percent. Conclusion BDI is a common severe complication in patients with LC. By suitable surgical management, it will achieve good recovery.