腹腔镜胆囊切除术致胆道损伤原因分析及防治策略

Analysis of the reasons of bile duct injury caused by laparoscopic cholecystectomy and investigation on its prevention and treatment methods

目的：探讨经腹腔镜胆囊切除术致胆道损伤发生的原因、治疗方法与预防措施。方法：收治完成经腹腔镜胆囊切除术并发生胆道损伤患者43例。结果：急诊手术31例(72.1%)，择期手术12例(27.9%)。术中发现胆道损伤27例(62.8%)，术后发现胆道损伤16例(37.2%)；分别行胆道修补、重建、胆肠吻合、胆道支撑等胆道修复方式，其中2例术后再发胆道狭窄，肝衰竭死亡1例，术后随访3个月～5年，优良率90.7%(39/43)。结论：腹腔镜胆囊切除术致胆道损伤的原因与局部解剖变异因素、病理因素、术者技术因素有关。

Objective:To investigate the causes,treatment and preventive measures of bile duct injury caused by laparoscopic cholecystectomy.Methods:43 patients with laparoscopic cholecystectomy reduced bile duct injury were selected. Results:There were 31 cases(72.1% ) in the emergency operation,12 cases(27.9% ) in the elective surgery.27 cases(62.7% ) of bile duct injury were found during the operation,and 16 cases(37.2% ) were found after the operatio.All those patients were treated with biliary reconstruction and repair,biliary enteric anastomosis,biliary tract support in bile duct reconstruction method respectively,in which there 2 cases recurrent biliary stricture after the operation,1 case died of liver failure,and the other patients were followed up from 3 months to 5 years.The excellent and good rate was 90.7% (39/43).Conclusion:Bile duct injury caused by laparoscopic cholecystectomy are related to the local anatomical variation,pathological factors and the technical factors.