熟悉胆囊管解剖特点预防腹腔镜胆囊切除术中胆管损伤的临床价值

The clinical value of familiarity of cystic duct anatomical features to prevent bile duct injury in laparoscopic cholecystectomy

目的:探讨胆囊管的解剖特点在腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中预防胆道损伤的应用价值。方法:回顾分析2005年1月至2011年12月施行2 140例LC的临床资料。结果:2 140例均成功完成LC,无一例肝外胆管损伤。2 072例有典型胆囊管解剖学特点,短胆囊管43例,胆囊管汇入胆总管过低10例,胆囊管开口于胆总管后壁9例,胆囊管与胆总管共同一侧壁并行6例。术后8例发生并发症,其中发生胆漏再次手术4例,穿刺孔出血1例,切口感染1例,胆总管残留结石2例,术后经ERCP取出结石。结论:熟悉胆囊管解剖特点是预防LC肝外胆管损伤的重要措施之一。LC术中在重视胆囊三角区仔细解剖的基础上,离断胆囊管前,不论胆囊管有无变异,均应根据胆囊管的解剖特点,明确无误后离断,以防止发生肝外主要胆管损伤。

Objective：To explore the clinical value of anatomical features of cystic duct to prevent bile duct injury in laparo- scopic cholecystectomy. Methods ： The clinical data of 2 140 cases of laparoscopic cholecystectomy between Jan. 2005 and Dec. 2011 in the First People~ Hospital of Y/bin were analyzed retrospectively. Results：All 2 140 cases were operated successfully with laparoscopic cholecystectomy, there was no extrahepatic bile duct injury in all the patients. There were typical anatomical features of cystic duct in 2 072 cases. The cystic duct was short in 43 cases. The anatomic variation of cystic duct included low location of the convergence of the cystic duct and the common bile duct （10 eases） , cystic duet opening into the posterior wall of the common bile duct in 9 cases, the cystic duct and common bile duct sharing lateral wall in 6 cases. There were postoperative complications in 8 cases, including biliary leakage in 4 cases （cured by a second operation）, bleeding at the puncture site in 1 case,infection of the puncture site in 1 case, and residual stones of common bile duct in 2 cases （cured by ERCP）. Conclusions：Familiarity of the anatomical feature of cystic duct is one of the important measures to prevent the incidence of extrahepatic bile duct injury in laparoscopic cholecystectomy. On the basis of paying attention to the careful anatomy of Calot triangle,the bile duct should be resected after its anatomy is clear,no matter whether or not there is variation of bile duct.