腹腔镜胆囊切除致胆道损伤26例分析

Bile duct injury during laparoscopic cholecystectomy

目的探讨腹腔镜胆囊切除术（1aparoscopic cholecystectomy，LC）致胆管损伤的原因、类型、临床表现、诊断及处理原则。方法回顾性分析1997-2007年收治的26例LC致胆管损伤的临床资料。结果胆管损伤Ⅰ型5例、Ⅱ型13例、Ⅲ型2例、Ⅳ型6例；3例术中发现胆管损伤并中转开腹，23例术后发现胆管损伤，其中13例为LC术后1周内发现，8例为术后20-60d发现，2例在术后2年表现反复胆管炎发作的症状；24例接受介入治疗，其中5例获得治愈，19例在胆管炎和黄疸控制后获得手术；切除毁损胆管20例，行肝总管或左右肝管的胆肠吻合术。结论胆道损伤是严重的LC术后并发症，应高度警惕。合理运用介入或手术的方法及时进行必要的胆管内支撑和通畅的胆汁外引流，应避免再次医源性损伤和修补术后胆道再狭窄。

Objective To investigate the cause, type, clinical manifestation, diagnosis and treatment of bile duct injury （BDI） during laparoscopic choleeystectomy （LC）. Methods Data of 26 cases suffering from biliary injury during LC from 1997 to 2007 were retrospectively analyzed. Results Among 26 cases with BDI, 5 cases suffered from type Ⅰ BDI, 13 cases from type Ⅱ , 2 cases from type Ⅲ, and 6 cases from type IV. Injuries were diagnosed as BDI intraoperatively in 3 cases, 23 BDI cases were diagnosed postoperatively, including 13 cases diagnosed one week after LC, 8 cases 20 -60 days after LC, 2 cases 2 years after LC. Twenty-four cases underwent interventional therapy, with 5 cases cured, 19 cases were tide-overed to operative treatment after cholangitis and jaundice were under control. Among all BDI cases, 20 cases underwent resection of impaired dile duct and hepatico-jejunostomy. Conclusion BDI is a serious complication of LC, temporary stent graft or bile dranage will help to put jaundice and eholangitis under control so as to buy a time for final definite surgical procedures.