腹腔镜胆囊切除中对肝外胆管变异的认识及处置

Anatomic variations of extrahepatic bile duct during laparoscopic cholecystectomy: recognization and management

目的:探讨腹腔镜胆囊切除术中对肝外胆管变异的认识和处置。方法 :分析2008年6月至2015年2月腹腔镜胆囊切除术中发现的42例肝外胆管变异。术中从胆囊壶腹部解剖胆囊管,明确三管关系,完成胆囊切除。结果:42例病人均顺利完成经腹腔镜胆囊切除术,无胆管损伤,效果良好,无胆管损伤并发症。结论:牢记肝外胆管变异的可能性,仔细正确处置,可有效帮助辨别肝外胆管的变异,避免医源性胆管损伤的发生。

Objective To recognize and manage the anatomic variations of extrahepatic bile duct during laparoscopic cholecystectomy. Methods Forty-two cases who underwent laparoscopic cholecystectomy and were found the anatomic varia-tions of extrahepatic bile duct in our department from June 2008 to February 2015 were studied retrospetively. Bile duct in-juries were avoided by dissecting gallbladder duct at the neck after recognizing three ducts that is common hepatic and common bile ducts and gallbladder duct which are located at Calot′s triangle. Gallbladder was resected and removed finally. Results All patients had undergone laparoscopic cholecystectomy successfully without bile duct injury. No conversion to open surgery was needed without any complications. Conclusions Identifying anatomic variations of extrahepatic bile duct with correct skill is helpful to prevent iatrogenic bile duct injury.