腹腔镜胆囊切除术后胆道损伤的处理策略

Treatment strategy of bile duct injury after laparoscopic cholecystectomy

目的 探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）术后胆道损伤时合理的处理策略.方法 回顾性分析11年间我院处理的17例LC手术后胆道损伤的临床资料,其中胆囊床小胆管损伤4例,采用缝扎或内镜下胆道引流;主要胆管部分损伤8例,采用单纯修补、内镜下引流、放置支架或胆管空肠Roux-en-Y吻合;胆总管或肝总管完全横断4例,予对端吻合或胆肠吻合;左右肝管横断1例,二期整形后行胆肠吻合.胆道再狭窄患者予内镜下扩张并置入支架,效果不佳者行胆肠吻合.结果 所有患者均无重大并发症发生,疗效满意.结论 LC手术胆道损伤重在预防,一旦损伤,需由有经验的胆道专科医生依据损伤情况选择干预方式,方能达到最好疗效.

Objective To explore the treatment strategy of bile duct injury after laparoscopic cholecystectomy（LC）. Methods The clinical data of 17 patients with bile duct injury after LC in our hos- pital were retrospectively reviewed. Four patients suffered with minor duct injury of the gallbladder bed were treated by suture or endoscopic bile duct draining; partial injury of the major duct happened in 8 pa- tients and was handled by simple repair, endoscopic draining or hepaticojejunostomy with Roux-en-Y anas- tomosis ; complete transection of common bile duct or common hepatic duct oecured in 4 patients and was treated with end-to-end anastomosis or bilioenteric anastomosis; transaction of right and left hepatic duct occured in one patients and was intervened by second reshaping and bilioenteric anastomosis;Recurrent stricture of bile duct was managed with endoscopic bile duct expansion and stent, and bilioenteric anasto- mosis was used as salvage treatment. Results All patients recovered satisfactorily without serious compli- cations. Conclusion The emphasis of managing bile duct injury after LC is prevention. Whenever the in- jury happened, the injury of bile duct should be evaluated and repaired by experienced surgeons to achieve the best results.