“三管一孔一脏器”显露在预防腹腔镜胆囊切除术胆管损伤的价值

Revelation of three duct, one hole and one organ in preventing bile duct injuries in laparoscopic cholecystectomy

目的研究胆囊各种病理形态、胆囊动脉变异和胆囊管变异情况下，腹腔镜胆囊切除术（ＬＣ）胆管损伤防治预案．方法ＬＣ患者１０６５例，急诊ＬＣ２０７例，择期ＬＣ８５８例，在全麻、ＣＯ２气腹状态下，采用经Ｃａｌｏｔ’ｓ三角后侧径路方法，显露“三管一孔一脏器”（ＴＯＯ）作为胆囊切除术的安全标志．结果“ＴＯＯ”显露１０２１例，占９５８６％，未显露４４例，占４１４％．胆囊动脉变异１４０例，胆囊管变异１５２例，均经ＬＣ顺利完成．全组无胆管损伤等并发症和死亡．结论“三管一孔一脏器”显露在ＬＣ预防胆管损伤起着重要作用．

AIM Preventive measures of bile duct injuries were studied in laparoscopic cholecystectomy (LC) with various gallbladder pathomorphology, variant arterial anatomy and variant cystic duct. METHODS One thousand and sixty-five patients with LC(207 in emergency and 858 in election) were observed . Under general anesthesia and carbon dioxide pneumoperitoneum, three duct, one hole and one organ (TOO) was used as safe measure in LC which was revealed through anatomizing lateral back of Calot's triangle. RESULTS TOO was revealed in 1021 patients and not revealed in 44 patients. Cystic variant arterial in 140 patients and variant cystic duct in 152 cases were successfully completed with LC. Bile duct injuries or death did not occur in any patient. CONCLUSION Revelation of TOO is important in preventing bile duct injuries in LC.