右肝管缺如与腹腔镜胆囊切除致胆道损伤

THE RIGHT HEPATIC BILE DUCT DELETION VS THE IATROGENIC BILE DUCT TRAUMA IN TELEVISION LAPAROSCOPIC CHOLECYSTECTOMY

探讨合并有右肝管缺如者行腹腔镜胆囊切除术时易致医源性胆道损伤的危险因素及防治方法。方法 :对该院 1990年 3月～ 2 0 0 1年 3月收治的 10例合并有右肝管缺如行腹腔镜胆囊切除术所致的医源性胆道损伤资料进行回顾性分析。结果 :合并有右肝管缺如者行腹腔镜胆囊切除时易致医源性胆道损伤。损伤原因主要是将右肝后叶胆管误认为胆囊管而一并切除。损伤部位以Ⅱ类多见。结论 :对右肝管缺如胆道异常解剖结构的认识及胆囊切除前遵循“辨 -切 -辨”三字原则是预防医源性胆道损伤的关键 ,而损伤后诊断时期与损伤类型则决定了外科手术方式的正确选择。

Objective:To study the risk factors and treatment of iatrogenic bile duct trauma (IBDT) resulted from television laparoscopic cholecystectomy(TVLC) in case of right hepatic bile duct (RHBD) deletion.Methods:A retrospective study was made on the clinical data of 10 patients with RHBD deletion and IBDT resulted from TVLC,which were admitted to the Hunan Provincial People' Hospital from Mar,1990 to Mar,2001.Results:IBDT occurred more often in TVLC in case of RHBD deletion.The main problem was mistaking the RHBD as cystic duct and the RHBD was resecteced with cystic duct together.According to the injury site of bile duct,IBDT could be divided into 4 types,the most common type of IBDT was resection of partial RHBD which occurred in 60%(6/10) of the patients.The cure rate of IBDT was 100% (10/10) due to the choice of operation according to the trauma type.Conclusions:The key prevention of IBDT lies in the knowledge to the abnormal biliary anatomical structure in case of RHBD deletion and abiding by the principle of 'identifying-cut-recognizing' during cholecystectomy.The choice for surgical operative procedure should agree with the trauma type and the diagnostic period after the bile duct injured.