电视腹腔镜胆囊切除术中胆管损伤的预防

PREVETION OF BILE DUCT HARMS CAUSED BY THE VIDEO-GUIDED LAPAROSCOPIC CHOLECYSTECTOMY

目的 探讨腹腔镜胆囊切除术预防胆管损伤的经验。方法 总结应用腹腔镜行胆囊切除术 140例无胆管损伤的实践。结果 平均手术时间 85± 35分钟 ,术后 136例病人翌日可在扶助下下床活动和开始进食 ,术后住院 3～ 5天。 1例发生胆漏和 1例局限性腹腔感染均经保守治疗痊愈 ,2例因严重粘连解剖变异而中转开腹手术也痊愈 ,均无胆管损伤和大出血等严重并发症。结论从造成胆管损伤的常见原因着手 :1技术及人为因素 ;2对手术困难估计不足和适应症选择不当 ;3炎症粘连 ;4结石嵌顿 ;5解剖变异 ;6未能果断中转开腹手术 ;认真做好预防胆管损伤的工作。

Objective To study the experience for prevention the bile duct harmed from laparoscopic chloecystectomy.Methods Sums up the practice of laparoscopic cholecystectomy 140 cases without bile duct injuries.Results Average surgical operation time were 85±35minutes,and 136 cases can go to bed and take food,and was in hospital 3-5 days after operation.1 case occurred gall leaking and 1 case occurred limitations abdominal cavity infection.They was cured with conservative treatment,2 cases was cured with transfer paunch operation because of the serious adhesio and anatomise abnormity.serious complication have no bile duct harms and massive haemorrhage etc.Conclusions To contrapose the common cause that creates the bile duct injury:(1)the technology and the artificial factor;(2)to estimate deficiency in the surgical operation difficulty and to select appliation is unsuitable;(3)the inflammation adhesion;(4)stone inlays;(5)anatomise abnormity;(6)late desision with transfer paunch operation;the work preventing bile duct injury is well done.