腹腔镜胆囊切除术致胆管损伤七例诊治分析

Diagnosis and treatment of 7 cases of bile duct injury caused during laparoscopic cholecystectomy

目的探讨基层医院腹腔镜胆囊切除术（LC）致胆管损伤的原因、特点及处理措施。方法回顾性分析自1997年10月至2012年3月间3152例LC术中胆管损伤7例的临床资料。结果胆管损伤7例，术中发现4例，术后发现3例。因技术因素致胆管损伤2例，病理因素2例，胆管解剖变异1例，人为因素2例。处理措施：行胆总管端端吻合＋T管支撑引流2例，胆总管修补＋T管支撑引流1例，肝总管修补＋T管支撑引流1例，右肝管修补放置“Y”型引流管2例，胆肠Roux-en-Y吻合1例。除1例胆管狭窄外，余均恢复良好。结论基层医院LC引起胆管损伤应引起足够重视，手术者经验技巧不足、胆道结构变异及局部病理改变是引起胆管损伤的主要原因，术中及时发现，及时处理胆管损伤是减少严重并发症的关键。

Objective To discuss the causes and characteristics of the bile duct injury, and well handed methods during laparoseopic choleeystectomy （LC） in the basic hospitals. Methods The clini- cal data of 7 cases of bile duct injury from 3 152 cases subject to LC from Oct. 1997 to Mar. 2012 were reviewed. Results Seven cases had transaction injury of biliary duct. Four cases were found during the operation and 3 cases after the operation. The common bile duct was injured by technical factors in two cases, by pathological factors in two cases, by bile duct anatomical variation factors in one case, by humanistic factors in two cases. Two cases were subjected to bile duct anastommsis （end-to- end anastommsis） and T-tube supporting and drainage, one case to the repair of common bile duct and supporting and drainage of T tube, one case to the repair of common hepatic duct and supporting and drainage of T tube. two cases to the right hepatic duct repair and Y-tube drainag, and one case to chole-enteroanastomosis （Roux-en-Y）. All the cases were cured. Conclusion We should put a sufficient premium on bile duct injury owing to LC in the basic hospitals. The main reasons of bile duct injury were the inexperience of surgeons, locally pathological changes and variation of bile duct structure. Timely diagnosis and treatment during operation are the key to reduce serious complications in bile duct injury.