单中心腹腔镜胆囊切除致胆管损伤近年变化及特点分析

Characteristics of bile duct injury induced by laparoscopic cholecystectomy： a single center report

目的总结单中心腹腔镜胆囊切除致胆管损伤近年的变化及特点。方法回顾性分析总结近期组（2003年6月至2009年3月）和早期组（1992年10月至1998年6月）进行腹腔镜胆囊切除术（LC）患者的临床资料，并进行对比分析。结果近期组18613例中发生胆管损伤11例（发生率0．06％），包括胆管横断伤2例（1例是中转开腹以后发生）、胆管分离性损伤3例、电凝伤2例（肝总管1例、副肝管1例）、胆总管部分剪切伤2例、副肝管横断伤1例、中转开腹肝总管部分缝扎伤1例；早期组11796例中发生胆管损伤15例（发生率0．13％），包括横断伤6例、电灼胆管侧壁伤6例、分离伤3例。近期组LC致胆管损伤的发生率明显低于早期组（χ2=3．92，P=0．04784）。结论近期组Lc致胆管损伤的发生率较早期组明显降低，损伤程度也在降低，但损伤种类在不断增加，依据胆管损伤的类型进行“个体化”处理可减少胆管进一步损伤以及术后并发症的发生。

Objective To study the characteristics and changes of bile duct injury induced by lapa- roscopic cholecystectomy （LC） in recent years. Methods The clinical data of patients who underwent LC between October 1992 and June 1998 （ early group） were compared with those between June 2003 and March 2009 （recent group）. Results Of 18,613 cases in recent group, the bile duct injury occurred in 11 cases （0.06%） , which included 2 cases of bile duct transection （ occurred during open cholecystectomy in 1 case）, 3 cases of dissociation impairment,-2 eases of electric coagulation injury （1 in common hepatic duct, the other accessory hepatic duct）, 2 cases of partial shearing in common bile duct, 1 case of accessory he- patic duct transection, 1 case of suture injury in common hepatic duct during open eholecystectomy. In 11, 796 cases of early group, bile duct injury occurred in 15 cases （0.13%） , including 6 cases of bile duct transection, 6 cases of electric coagulation injury to lateral extrahepatic bile duct and 3 cases of dissociation impairment of bile duct. Injury-rate.of bile duct in recent group was significantly lower than that of the early group （χ2 = 3.92, P = 0. 04784）. Conclusion The incidence of bile duct injury induced by LC in recent years is significantly lower than that in years before, so is the severity of injury, while the types of bile duct injury are increasing. Individualized management can prevent further injury to the bile duct, as well as post- operative complications.