腹腔镜胆囊切除术致胆管损伤的防治

The preventive and therapeutic strategy of bile duct injury in laparoscopic cholecystectomy

目的探索腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)致胆管损伤的防治策略。方法回顾性分析1033例腹腔镜胆囊切除术中发生12例胆管损伤的原因及处理措施。结果 10例小破口损伤(破损范围在3mm以下),行可吸收线一期修补及T管引流;2例破损严重者行胆肠Roux-en-Y吻合术。随访6～12月,无胆管狭窄、继发性结石等并发症发生。结论解剖变异、病变程度、术者的责任心和技术因素是LC致胆管损伤的主要原因。胆道损伤应及时发现,根据分型正确处理,以达到满意的预后。

Objective To explore the preventive and therapeutic strategy of bile duct injury caused by laparoscopic cholecystectomy（LC）.Methods We retrospectively analyzed 12 cases of bile duct injury in 1033 cases of laparoscopic cholecystectomy performed.Results According to Strasberg classification,10 cases with diameter=3mm were cured by sewing up the wound of bile duct and placing T type tube to drain bile,while the other two cases were cured by cholangioplasty and cholangiojejunum Roux-en-Y anastomosis.Through 6 months to 1 years follow-up,no such complications as bile duct stricture or lithiasis were found.Conclusion The primary reason is lack of understanding of the anatomy variety and pathological change,as well as responsibility and experience or skill of the operaters.The bile duct injurycaused by LC should be found and tackled in time in order to achieve satisfactory prognosis.