腹腔镜胆囊切除术中胆管损伤的预防及处理

Prevention and management of iatrogenic bile duct injury in laparoscopic cholecystectomy

目的探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中胆管损伤的原因、预防措施及处理方法。方法1999年10月至2009年10月行LC7431例,术中发生胆管损伤16例,对其临床资料进行回顾性分析。结果16例胆管损伤病人,术中发现12例(75.00%)。损伤类型为:高位胆管损伤2例,胆总管横断4例,右肝管横断2例,迷走肝管及副肝管损伤4例,右肝管电灼伤1例,肝总管电灼伤1例,胆囊管拔断1例,胆囊管与胆总管交汇处撕裂1例。结论腹腔镜下胆管损伤的原因是多方面的,注重胆囊Calot三角区的操作技巧及复杂胆囊的对策,可显著减少胆管损伤的发生;对于胆管损伤应争取术中尽早发现,适时恰当处理。

Objective To discuss the causes, preventive measures and management of iatrogenic bile duct injury in laparoscopic cholecystectomy（LC）. Methods The causes of 16 cases of bile duct injury among 7431 patients receiving LC form Oct. 1999 to Oct. 2009 were analyzed retrospectively. Results Iatrogenic bile duct injury was found in 12 cases during operation,and in 4 cases after operation. Types of injuries included high bile duct injury in 2 cases, transverse injury of common bile duct in 4 cases, transverse injury of right hepatic duct in 2 cases, aberrant bile duct and tiny subsidiary hepatic duct injury in 4 cases,burn injury of fight hepatic duct in 1 case,burn injury of common hepatic duct in one case, pull off of cystic duct in one case, and laceration of intersection of cystic duct and common bile duct in one case. Conclusion There are many reasons for bile duct injury. Paying attention to operation skills of gallbladder Calot triangle and countermeasures for complex gallbladder can substantially reduce the incidence of bile duct injury.