再认识开腹胆囊切除术(附1032例报告)

目的探讨开腹胆囊切除术(OC)中可致医源性胆道损伤的高危因素及预防措施。方法报告本院1998年至2011年OC1032例,发生医源性肝外胆道损伤3例,复习文献,认识OC的关键是胆囊三角的解剖,比较顺行法、逆行法和顺逆行结合法OC的安全性。结果本组3例医源性胆道损伤,发生率0.29%(3/1032),其中2例发生于顺行法,1例发生逆行法,损伤的原因均与解剖胆囊三角有关,顺逆行结合法无医源性胆道损伤。结论 OC医源性胆道损伤的高危因素包括解剖、病理和手术等,OC的关键是胆囊三角的解剖。顺逆行结合法OC更安全。了解医源性胆道损伤的原因,熟悉正常解剖及解剖变异,高度重视及规范手术操作,防止术中意外损伤发生。

Objective Explore the open choiecystectomy （OC）can be caused by iatrogenic bile duct injury risk factors and preventive measures. Methods Report our hospital from 1998 to 2011 OC1032 cases, the occurrence of iatrogenic extrahepatic bile duct injury in three cases and review of the literature, the key to understanding OC is the anatomy of the gallbladder triangle, compare anterograde method, retrograde cis retrograde binding assay, OC security. Results This group three cases of iatrogenic bile duct injury, the incidence of 0.29% （3/1032）, two cases of which occur in anterograde method, 1 case of retrograde reason of the injury and the anatomy of the gallbladder triangle, the combination of good or poor linelaw iatrogenic bile duct injury. Conclusion Iatrogenic bile duct injury in OC risk factors, including anatomy, pathology and surgery, OC The key is the anatomy of the gallbladder triangle. Good times or bad line combination of OC and more secure. Understand the reasons of iatrogenic bile duct injury, normal anatomy and anatomic variations of familiar, attaches great importance to standardize the surgical procedure, to prevent intraoperative accidental injury.