Rouviere沟引导的胆囊后三角入路在预防腹腔镜胆囊切除术中胆管损伤的作用

Role of Rouviere＇s sulcus in relation to posterior cystohepatic triangle in prevention of bile ductinjury in laparoscopic cholecystectomy

目的探讨腹腔镜胆囊切除术中采用Rouviere沟引导定向联合胆囊后三角入路的方法预防胆管损伤的作用。方法回顾性分析2016年5月至2017年6月芜湖市第二人民医院肝胆外科实施的170例腹腔镜胆囊切除术，采用Rouviere沟引导的胆囊后三角入路的解剖显露方法，术中记录Rouviere沟的出现率及分型。结果170例患者中Rouviere沟开放型108例（63．53％），融合型44例（25．88％），缺失型18例（10．59％），可见型（开放型＋融合型）共152例（89．41％）。全组均安全完成腹腔镜胆囊切除术，无一例胆管损伤及手术死亡，其中中转开腹4例（2．35％），Rouviere沟均为缺失型，胆囊三角因反复的慢性炎症而无法清晰显露。结论Rouviere沟存在于绝大多数人中。Rouviere沟引导定向联合胆囊后三角入路的方法，能安全、有效地显露胆囊三角的解剖结构，预防术中胆管损伤。

Objective To evaluate the function of Rouviere＇s sulcus with posterior cystohepatic triangle in prevention of bile duct injury in laparoscopic cholecystectomy. Methods The clinical data of 170 patients undergoing laparoscopic cholecystectomy through Rouviere＇s sulcus approach with posterior cystohepatic triangle from May 2016 to June 2017 in the Department of General Surgery, the Second People＇s Hospital of Wuhu were retrospectively analyzed. The incidences and types of Rouviere＇s sulcus were documented. Results The open type of Rouviere＇ s sulcus was visualized in 108 patients （63.53%）, the fused type in 44 patients（25.88% ） ,and the deficient type in 18 patients （ 10. 59% ）. Hence in a total of 152 （89.41%） patients had Rouviere＇s sulcus. All patients underwent laparoscopic cholecystectomy safely. There was no bile duct injury or mortality. Four patients （2. 35% ） were converted to open operation, all were deficient type of Rouviere＇ s sulcus for chronic inflammation of the gallbladder triangle. Conclusion Rouviere＇s sulcus are present and visible in most patients. Guided by Rouviere＇s sulcus with posterior cystohepatic triangle it could be safely and effectively to expose the anatomical structure of Calot＇s triangle and prevent bile duct injury in laparoscopic cholecystectomy.