腹腔镜胆囊切除致胆管损伤8例分析

Clinical analysis of 8 patients with bile duct injury caused by laparoscopic cholecystectomy

目的 分析腹腔镜胆囊切除术 (L C)致胆管损伤的具体原因以提高诊治水平。方法 就 L C手术发生胆管损伤 8例具体病例 ,分析胆管损伤形成原因、补救措施并进行随访。结果 肝总管横断 1例 ,胆总管分离损伤 2例 ,电灼穿孔 1例 ,胆囊管残端漏 2例 ,不明原因胆漏 2例 ,分别经肝总管端端吻合、胆总管直接修补、“T”管支架引流、胆囊管结扎、鼻胆管引流、保守治疗等治愈。平均随访 2 7个月 ,无胆管狭窄。结论 强调术者人为因素包括经验、操作水平、防犯意识的重要性 ,建议逆行分离、胆囊减压方法的应用 ,在 A型和

Objective To analyze the reasons for bile duct injury(BDI) caused by laparoscopic cholecystectomy(LC) in order to improve surgical treatment of LC.Methods Eight patients of BDI caused by LC in our hospital during 1996～2001 were analyzed retrospectively.Results The common hepatic duct transection was found in 1 cases,common bile duct dissection injury in 2 cases and electric cautery injury in 1 case,remnant cystic duct leakage in 2 cases,bile leakage of unknown origin in 2 case.End to end anastomosis of the common hepatic duct,direct repair of common biliary duct,T tube drainage,reliable ligation of cystic duct and transnasal bile duct drainage were performed respectively according to the types of trauma.All of these 8 cases recovered well and no biliary stricture occurred during the follow up period ranging from 1 to 5 years.Conclusion Operator's personal factors such as experience,technique,protective intention are emphasized.Gallbladder decompression,retrograde dissection of gallbladder are recommended.Transnasal bile duct drainage may be used in A and D type injury to avoid operation again.