腹腔镜胆囊切除胆管损伤的预防及处理

The prevention and treatment of bile duct injury in laparoscopic cholecystectomy

目的 总结腹腔镜胆囊切除 (LC)胆管损伤的预防及处理经验。方法 回顾性分析 3 1例LC胆管损伤患者的临床资料。 3 1例中一期手术修复处理损伤 2 7例 ,姑息性胆道外引流 4例。结果 一期修复处理损伤 2 7例中成功 16例 ,失败 11例。全组有 15例经 2～ 4次手术 ,再手术率 48.4%。全组 2 9例治愈 ,2例死亡。结论 LC手术过程应严格遵守操作规程 ,避免盲目或轻率的钳夹、电切、电凝是预防胆管损伤的关键。

Objective To summarize the experience in prevention and treatment of bile duct injury during laparoscopic cholecysteclomy(LC). Methods Retrospective analysis on the clinical data of 31 cases of LC was carried out. Of them, 27 underwent one stage operative repair and 4 underwent palliative external drainage of the bile duct first. Results 16 cases succeeded and 11 failed in the one stage operative repairing.There were 15 cases underwent 2～4 operations in this series,and the re-operation rate was 48.4%. 29 patients was cured while 2 died. Conclusions During LC, the operative rule should always be strictly observed, and the key to preventing bile duct injury is to avoid clipping, cutting and coagulation blindly.