腹腔镜胆囊切除术预防肝外胆管损伤的探讨

The study on prevention of extrahepatic bile duct injury in laparoscopic cholecystectomy

目的 :研究腹腔镜胆囊切除术中预防肝外胆管损伤的有效方法。方法 :分析腹腔镜胆囊切除术10 80 0例的临床资料 ,肝外胆管损伤 8例 ,损伤率 0 0 8% ,以肝外胆管横断伤多见共 6例 ,电灼伤和钳闭坏死各 1例。 8例损伤均发生在开展腹腔镜前 5年的 5 0 0 0例中 ,后 5年 5 80 0例LC无发生肝外胆管损伤患者。结果 :8例肝外胆管损伤均行胆肠Roux -en -y吻合术治愈。结论 :良好显露Calot三角 ,靠胆囊钝性分开Calot三角 ,认准胆囊壶腹与胆囊管交汇部并游离出其延伸段是确认胆囊管的可行方法 ,此时 ,多能辨清肝总管、胆总管、胆囊管、胆囊壶腹即“三管一壶腹”的相互解剖关系 。

Objective:To study the prevention of extrahepatic bile duct injury in laparoscopic cholecystectomy(LC). Methods:In 10 800 cases with LC, 8 cases had extrahepatic bile duct injury. The rate of extrahepatic bile duct injury was 0 08%, Six of them were transecting injury of extrahepatic bile duct,one of them was injuried by Tiantanium clip one by electric coagulation. And all of patients with extrahepatic bile duct injury occurred in former 5 years out of former 5000 cases with LC. However, there were no extrahepatic bile duct injury in later 5 years out of later 5800 cases with LC. Results:8 cases of extrahepatic bile duct injury underwent Roux en y anastomosis were cured.Conclusions:Tactics to avoid such accident were sumed as the following:properly exposing the Calot′s triangle, carefully districting the connecting site of cystic ampulla and cystic duct, carefully recognition and verfication of relations of cystic duct, common bile duct, hepatic bile duct and cystic ampulla.