腹腔镜胆囊切除致胆管损伤5例

A report of 5 patients with bile duct injury caused by laparoscopic cholecystectomy

目的探讨 LC 致胆管损伤的原因。方法回顾性地分析了开展 LC 以来遇到的5例胆管损伤的具体原因,总结了防止 LC 致胆管损伤的几点经验。结果 5例中2例于术中发现,分别行“T”管支架引流和端端吻合“T”管支架引流,痊愈而无后遗症。另3例分别行右肝管空肠 Roux-en-Y 吻合和肝门空肠 Roux-en-Y 吻合,其中2例发生逆行感染。结论 LC 致胆管损伤最主要的原因并非是由于解剖异常,人为因素、电凝或电钩的盲目使用才是最主要的原因。

Objective To investigate the reasons for bile duct injury (BDI) caused by laparo- scopic cholecystectomy (LC).Methods From 1993 to 2000,5 cases of BDI caused by LC occurred in our hospital.We explored its reasons and summed up experience.Results Amongst these 5 cases,2 were discovered during the operation.They were supported and drained by T-shape tube before or af- ter the end-to-end anastomosis.Thus they had no any sequelae.The other three were discovered in 3 days,9 days and 2 months after the operation,respectively.They were operated on with Roux-en-Y hepaticojejunostomy and right hepatic duet cholangiojejunostomy.Retrograde infection occurred in two of them.Conclusions The anatomic abnormality is not the most important factor for BDI during LC. Artificial factors as well as blind use of electric torch or electric seduce are the most important reasons.