腹腔镜胆囊切除术致胆管损伤的特点、处理及预防方法

Characteristics,management and prevention of bile duct injury caused by laparoscopic cholecystectomy

目的探讨腹腔镜胆囊切除术致胆管损伤的特点及处理方法,强调术中胆道造影的重要性。方法回顾总结我院1994～1999年间腹腔镜胆囊切除术3 550例,致胆管损伤31例的损伤特点。结果 31例均顺利恢复,随防1个月至6年,无胆管狭窄。结论腹腔镜胆囊切除术致胆管损伤与开腹胆囊损伤比较,有其特点。通过胆道术中造影,绝大多数胆管损伤病例能在术中发现。术中发现立即修复,结果比较理想,处理方法亦灵活多样。

Objective To explore characteristics and management of bile duct injury caused by laparoscopie cholecystectomy and emphasize the importance of intraoperative cholangiography.Meth- ods Clinical data of 31 cases of bile duct injury caused by laparoscopic eholecystectomy appeared in our hospital during 1994—1999 were retrospectively analyzed.Results All these 31 cases recovered well and no biliary stricture occurred during the follow-up ranging from 1 month to 6 years.Conclu- sions Comparing with injuries caused by laparotomic cholecystectomy,the bile duct injury caused by laparoscopie cholecystectomy has its own characteristics.Most of the cases of the injury can be detec- ted intraoperatively by intraoperative cholangiography.If the injury could be found introperatively,the outcome of immediate repair would be satisfactory.Meanwhile,the methods of management are multi- ple and flexible.