腹腔镜胆囊切除术中胆管损伤的术中镜下修复

Laparoscopic Repair of Bile Duct Injury in Laparoscopic Cholecystectomy

目的总结腹腔镜胆囊切除术（1aparoscopic cholecystectomy，LC）中胆管损伤的原因及术中镜下修复经验，探讨术中腹腔镜下修复胆道损伤的可行性。方法我院2001年7月～2012年9月共完成7例Lc术中胆管损伤的镜下修复，其中1例肝总管完全横断伤、1例胆总管完全横断伤及1例左肝管不完全横断伤、1例右肝管不完全横断伤、1例肝总管不完全横断伤采用胆管对端吻合T管引流术；1例左、右肝管汇合下方肝总管前壁直径10Inln缺损，采用转移胆囊管壁瓣修复肝管缺损T管引流术；1例肝总管不完全横断伤采用对端吻合，未留置T管。结果所有手术均获成功，无中转开腹。1例胆总管对端吻合病例术后胆漏，腹腔引流管引流20d愈合。余无并发症出现。6例放置T管引流者术后1年拔除T管。7例术后随访0．5～10年，平均3．2年，无腹痛、黄疸、发热，肝功能正常，B超未见胆管扩张。结论LC胆管损伤的术中修复可以在腹腔镜下顺利完成．

Objective To summarize the repair experience of bile duct injury in laparoscopic cholecystectomy （LC） and explore the feasibility of laparoscopic bile duct repair. Methods Seven cases of bile duct injury in LC received repair surgery under laparoscope in our hospital from July 2001 to September 2012, including 1 case of complete hepatic duct transection, 1 case of complete common bile duct transection, 1 case of incomplete left hepatic duct transection, 1 case of incomplete right hepatic duct transection and 1 case of incomplete hepatic duct transection, which were treated by end to end anastomosis and T tube drainage; 1 case of 10 mm in diameter defect in the anterior wall of the hepatic duct, which was cured by transfer of the cystic duct and T tube drainage; and 1 case of incomplete hepatic duct transection, which was cured by end to end anastomosis without T tube drainage. Results All surgeries were successful, with no conversion to laparotomy. One case of bile leakage occurred in hepatic anastomosis and was cured by peritoneal drainage in 20 days. No other complications occurred. T-tube drainage was implemented in six patients and was removed 1 year later. Seven cases were followed up for 0.5 to 10 years （ average, 3.2 years） and no jaundice, abdominal pain, or fever was observed. Liver function was normal and B-mode uhrasonography didn＇ t show cholangiectasis. Conclusion Laparoscopic repair of bile duct injury in LC can be successfully performed under laparoscope.