胆囊切除胆道损伤的手术治疗

Surgical treatment of bile duct injury caused by cholecystectomy

目的胆囊切除术,无论传统开腹手术还是腹腔镜下操作,都有可能损伤胆道,后果是灾难性的。该研究旨在总结治疗这一严重并发症的手术方法,并评价治疗结果。方法对盛京医院2011年1月-2013年12月手术治疗的11例胆囊切除术后胆道损伤的患者,回顾分析临床病例特点、胆道损伤时间及程度,总结手术方式选择,并对治疗效果进行评价。结果除3例患者外院转入外,其余8例发生于该院。所有病例中因腹腔镜手术发生胆道损伤9例,开腹手术2例。有6例在术中发现胆道损伤,5例术后发现。除1例发生在该院急诊腹腔镜胆囊切除术以外,其余10例为平诊手术。2例损伤胆总管侧壁,予以无损伤线缝合修补,2例损伤胆总管接近半周,行胆总管T管引流术;7例胆总管横断,行肝总管空肠Roux-en-Y吻合术。经过术后中位随访29.2个月（15~41个月）,除1例发生胆肠吻合口狭窄经过再次手术治愈外,余10例治疗效果良好。结论胆囊切除术发生胆道损伤的并发症在所难免,及时发现并采用手术治疗效果肯定。

【Objective】Cholecystectomy could damage biliary tract, whether traditional laparotomy or laparoscope. The consequence is disastrous. This research was to summarize the experience of surgical treatment for this complication and assess the outcome. 【Methods】Between January 2011 and December 2013, 11 patients with bile duct injury following cholecystectomy were treated in our center. According to the difference of appearing injury time and degree, we employed direct suturation or choledochus T-tube drainage process or Roux-en-Y hepaticojejunostomy. We also evaluated the curative effect. 【Results】We found 9 cases of biliary injury by laparoscopic cholecystectomy（LC）, and 2 cases of biliary injury by cholecystectomy. Six cases of biliary injury were found during operation and 5 cases after operation. One appeared in emergency laparoscopic cholecystectomy, the other 10 were in selective operation, including 8 LC and 2 laparotomy. All the injury sites were choledochus, 2 cases were small part injury and treated by direct suturation, 2 cases of injury were near half of the choledochus and treated by choledochus Ttube drainage process, and 7 were choledochus abscission, treated by hepaticojejunostomy Roux-en-Y process. After29.2 months follow-up, all the cases healed except one case, who underwent one more operation for the stenosis of anastomotic stoma. 【Conclusion】Biliary tract injury could occur during cholecystectomy, which is serious and unavoidable. Therapeutic effect of operation is good when the injury is found in time.