腹腔镜胆囊切除术致胆管损伤18例临床分析

Clinical analysis of 18 cases of bile duct injury caused by laparoscopic cholecystectomy

目的探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)致胆管损伤原因及处理方法。方法回顾性分析我院2005-2011年18例腹腔镜胆囊切除术致胆管损伤临床资料,并总结胆管损伤的原因、类型及处理方法。结果 18例胆管损伤原因主要是因胆囊炎症致胆囊三角解剖不清及解剖变异、操作不当等,其中7例行可吸收无损伤线直接缝合破损处、7例用可吸收生物夹夹闭胆管破损处、3例中转开腹行"T"管引流术、1例行胆肠Roux-en-Y吻合术,18例均得到治愈。结论胆管损伤是严重的腹腔镜胆囊切除手术并发症,应早期预防和发现胆管损伤,不可盲目追求腹腔镜胆囊切除术的手术率和低的中转开腹率。

Objective To explore the reasons and treatment methods of bile duct injury induced by laparoscopic cholecystectomy（LC）.Methods The clinical data of 18 cases of bile duct injury caused by LC from 2005 to 2011 were retrospectively analyzed,and the reasons,types and treatment methods of bile duct injury were summarized.Results The main reasons of 18 cases of bile duct injury were unclear anatomy and variation of Calot＇s triangle induced by cholecystitis,and improper operation.All 18 cases were treated correctly and cured.Of them,7 cases were cured by suturing breakage with absorbed line,7 cases by clamping breakage with absorbed biological folder,3 cases were converted to open surgery with T tube drainage,and one case was cured by Roux-en-Y biliary-enteric anastomosis.Conclusion Bile duct injury is a serious complication of LC.Early prevention and detection of bile duct injury should be paid attention to,and it should be avoided to blindly pursue the operation rate of LC and low rate of conversion to open surgery.