腹腔镜胆囊切除术致胆管损伤的临床分析

A Clinical Analysis of Bile Duct Injury Caused by Laparoscopic Cholecystectomy

目的探讨腹腔镜胆囊切除术（LC）致胆管损伤的原因及防治措施。方法回顾性分析2008年7月至2014年7月我院实施的2130例LC术中发生6例胆管损伤的临床资料。结果本组胆管损伤5例于LC术中发现,1例于LC术后5 d发现。其中3例胆管小破口损伤直接单纯缝合;2例损伤较重者缝合修复并置T管引流;1例损伤严重者端端吻合失败,3个月后再行胆管空肠Roux-en-Y吻合术。本组病例均恢复良好,随访6个月∽5年,无胆管狭窄等并发症发生。结论解剖变异、病理改变、术者操作技术等是LC致胆管损伤的主要因素。遵循LC操作原则,规范操作,精细分离,可预防和减少胆管损伤。把握中转开腹指征及时机,胆管损伤尽早发现、及时正确处理是改善预后的关键。

Objective This paper aims to probe into the reasons and controlling measures for bile duct injury caused by laparoscopic cholecystectomy（LC）. Methods There will be a retrospective analysis of the 6 cases of bile duct injury occurred among the 2130 laparoscopic cholecystectomy operations taken from July 2008 to July 2014 at Zhongtang People＇s Hospital. Results 5 cases of bile duct injury took place during the LC operation, while 1 after it. Three small injuries were merely sutured, 2 severer injuries were sutured and drainage was done with T-shaped tube, while 1 end-to-end suture failed and the Rouxen-Y anastomosis had to be taken after 3 months. Patients in these cases all had a good recovery and no complications like stenosis of bile duct occurred in the follow-up of 6 months to 5 years. Conclusion Anatomic variation, pathologic change and the operation technique of the surgeon are the causes of the bile duct injury in LC. Following the operation principle, standard operation and fine separation can help prevent and reduce cases of bile duct injury. Seizing the chance of conversion to laparotomy, early discovery and prompt and correct treatment of bile duct injury are the key elements to improve prognosis.