49例腹腔镜胆囊切除术所致医源性胆管损伤的处理

Treatment of the Biliary Injury after Laparoscopic Cholecystectomy

目的探讨腹腔镜胆囊切除术所致胆管损伤的处理时机及疗效评价。方法回顾总结2001年1月至2011年12月期间我院收治的49例腹腔镜胆囊切除术所致医源性胆道损伤患者的临床资料,对损伤胆道的手术时机及其疗效进行分析。结果 49例患者中,29例行肝管空肠Roux-en-Y吻合术,19例行胆管空肠Roux-en-Y吻合术,1例行胆总管修补术。10例在腹腔镜胆囊切除术后3d内再次手术,27例在3 d～6周内再次手术,12例在6周后再次手术。15例患者出现不同的远期或早期并发症。统计学分析发现,在3 d～6周内再次手术的患者较容易出现胆道狭窄(P=0.03)。结论胆道损伤修复手术在胆道损伤后3d内或6月后施行可减少胆道狭窄的发生。

Objective To explore the opportunity and the approach of surgery in laparoscopic chole- cystectomy-associated bile duct injury patients. Methods A retrospective medical record was collected in 49 patients who underwent surgical repair between January 2001 and December 2011. Univariate statistical a- nalysis was used to identify risk factors for postoperative complications. Results 29 cases of hepatieojeju- nostomies, 19 of choledochojejunostomies, and 1 of primary common bile duct repair were performed. 10 re- ceived immediate repairs （0 ~ 72 hours post LC ） , 27 received intermediate repairs （72 hours -6 weeks ） , and 12 received late repairs （6 weeks later）. 15 patients developed short-term or long-term postoperative complications. Patients with intermediate repairs were more likely to develop biliary stricture than that of the immediate or late periods （P = 0.03 ）. Conclusions The timing of repair is an important determinant of long-term outcome. Repairs in the intermediate period were significantly associated with biliary stricture. Thus, repairs should be undertaken either in the immediate （ within 72hours） or delayed （6 weeks later） pe- riods after LC.