腹腔镜胆囊切除术胆管损伤的原因、类型及处理

Causes,Classes and Management of Bile Duct Injuries in Laparoscopic Cholecystectomy

报道7911例腹腔镜胆囊切除术(LC)中31例胆管损伤。男7例,女24例,年龄25～71岁。急诊LC2例,择期29例。在损伤原因中,解剖病理因素14例占45.16％,LC操作因素17例占54.84％。Calot三角粘连、纤维化引起6例,胆囊颈部结石嵌顿、肿大6例,解剖变异2例,出血损伤5例,钛夹损伤5例,辨认错误3例,技术因素4例。在损伤类型上,电凝灼伤2例,胆管穿孔伤6例,胆管撕裂伤5例,钛夹伤5例,胆管壁部分缺损5例,横断伤5例,截断伤3例。胆管损伤部位:胆总管13例,肝总管12例,胆总管、肝总管共同3例,右肝管3例。LC术中认识胆管损伤19例,手术后期因黄疸和胆汁漏而诊断胆管损伤12例。讨论了LC胆管损伤原因、类型及处理。

That bile duct injury was one of the most severe complications of laparoscopic cholecystectomy(LC). 7 911 patients were treated with LC from 1992 to 1996 in our hospital,in which 31 patients(7 men and 24 women,ranging in age from 25 to 71 years)had bile duct injured. Elective LC was performed in 29 cases and urgent LC in 2.The causes of bile duct injury were Calots triangle adhesion and dense scars(6 cases) ,gallbladder swelling with stone incarceration(6 cases) .anatomic variation(2 cases),injury with bleed-ing(5 cases), injured by Ti clip(5 cases), recognization error injury(3 cases) and technology factors(4 cases) respectively. The classes of bile duct injury included electrocoagulatibn bum(2 cases) perforation of bile duct(6 cases) ,laceration(6 cases) ,Ti chp injury(4.cases),breach of duct wall(5 cases) ,cross(5 cases)and cut(3 cases)respectively. Common bile duct,common hepatic duct and right hepatic duct injuries were presented in 16,12 and 3 patients respectively. Of the injuries, 19 cases were recognized initially,and 12 cases were diagnosed in the postoperative period. The causes and management of bile duct injuries were discussed in detail.