腹腔镜胆囊切除术致胆道损伤原因分析及预防

The Analysis and Prevention of Bile Duct Injury Due to Laparoscopic Cholecystectomy

目的探讨经腹腔镜胆囊切除术（LC）致胆道损伤的原因及预防措施。方法选择2003年1月-2012年12月完成LC并发生胆道损伤患者18例,发生率0.4%。其中男5例,女13例;年龄29-63岁,平均（42.3±3.6）岁。对LC引起胆道损伤患者的临床资料进行回顾性分析。结果 18例患者中,行急诊手术5例,择期手术13例;主刀医师为主治医师13例,副主任医师及主任医师5例;术中错认胆囊管9例,解剖变异致损伤3例,胆囊管牵拉过度引起胆总管部分损伤2例,Mirrizi综合征Ⅰ型手术损伤2例,胆囊床剥离过深及胆囊三角内损伤右肝管1例,胆囊管断端瘘1例。结论 LC引发的胆道损伤主要有手术术者经验、局部粘连严重和胆道变异等原因。应该严格手术准入制度,慎重选择患者,术中有困难及时中转开腹,重视手术经验及技巧的积累。

Objective To explore the causes of bile duct injury due to laparoscopic cholecystectomy（LC） and the preventive methods. Methods A total of 18 patients with bile duct injury（with the occurrence rate of 0.4%） after LC between January 2003 and December 2012 were included. The patients included 5 males and 13 females with the age of 29-63 years old [averaging（42.3±3.6） years old]. The clinical data of the patients were retrospectively analyzed. Results In the 18 cases of bile duct injury, 5 cases occur in emergency operation, 13 cases in selective operation. The operators were attending physician in 13 cases, and senior position in the other 5 cases. The reasons of the injury included misjudgment of the cystic duct in 9, duct aberrance in 3, excessive stretch of cystic duct in 2, 2 Mirizzi syndrome with Ⅰ-type surgical injury in 2, and right liver duct injury because of inappropriate stripping of gallbladder in 1. Conclusions The operator＇s experience, severe conglutination and the bile duct aberrance are the chief causes. Preventive methods include strict system of operation accession, careful selection of candidates, timely laparotomy, and paying attention to the accumulation of operation experience and skills.