胆结石合并胆囊炎患者腹腔镜切除术致胆道损伤的原因及预防研究

Study on the causes and prevention of bile duct injury caused by laparoscopic resection in patients with gallstones and cholecystitis

目的探究行腹腔镜胆囊切除术(LC)治疗胆结石合并胆囊炎患者致胆道损伤(BDI)的原因及预防研究。方法选取2013年8月至2019年8月于该院肝胆外科接受LC治疗的胆结石合并胆囊炎患者共计5106例,其中因LC致胆道损伤的患者19例。结果接受LC治疗的胆结石合并胆囊炎患者19例发生了BDI,发生率为0.37%(19/5106)。研究发现,LC致BDI主要分为电凝损伤(57.89%)、断离伤(26.32%)、夹闭伤(15.79%),胆囊管变异(10.53%)、胆总管粘连(15.79%)、胆囊管结石(26.32%)、LC操作损伤(47.37%)是其主要原因,多因素分析显示,胆囊炎性质(OR=0.312,95%CI 0.168~1.580)、胆囊三角解剖结构(OR=0.290,95%CI 0.136~0.621)、胆囊壁厚度(OR=0.344,95%CI 0.283~0.419)、胆囊萎缩(OR=0.363,95%CI 0.246~0.535)、术者资质(OR=0.333,95%CI 0.165~0.672)等因素是因LC致BDI的危险因素(P<0.05)。结论慢性胆囊炎、胆囊三角解剖结构异常改变、胆囊壁厚度>4 mm、胆囊萎缩及术者缺乏经验是行LC治疗的胆结石合并胆囊炎患者发生BDI的危险因素。行LC治疗胆结石合并胆囊炎患者时,建议将胆囊全部切除,及时处理粘连、炎症等,避免损伤胆管。

Objective To explore the causes and prevention of bile duct injury(BDI)in patients with gallstones complicated by cholecystitis treated with laparoscopic cholecystectomy(LC).Methods A total of 5106 patients with gallstones and cholecystitis who received LC treatment at the Department of Hepatobiliary Surgery in our hospital from August 2013 to August 2019 were selected,including 19 patients with biliary tract injury due to LC.Results From August 2013 to August 2019,19 patients with gallstones and cholecystitis who underwent LC treatment at the Department of Hepatobiliary Surgery in our hospital developed BDI,with an incidence rate of 0.37%(19/5106).The study found that BDI caused by LC is mainly divided into electrocoagulation injury(57.89%),rupture injury(26.32%),clipping injury(15.79%),cystic duct variation(10.53%),common bile duct adhesion(15.79%),gallbladder Duct stones(26.32%)and LC operation injury(47.37%)are the main reasons.Multivariate analysis showed that the nature of cholecystitis(OR=0.312,95%CI 0.168-1.580),the anatomical structure of the gallbladder triangle(OR=0.290,95%CI 0.136-0.621),gallbladder wall thickness(OR=0.344,95%CI 0.283-0.419),gallbladder atrophy(OR=0.363,95%CI 0.246-0.535),surgeon qualification(OR=0.333,95%CI 0.165-0.672)and other factors are risk factors for BDI due to LC(P<0.05).Conclusion Chronic cholecystitis,abnormal changes in the anatomical structure of the gallbladder triangle,gallbladder wall thickness>4mm,gallbladder atrophy and lack of experience of the surgeon are the risk factors for BDI in patients with gallstones and cholecystitis undergoing LC treatment.When LC is used to treat patients with gallstones and cholecystitis,it is recommended to remove all the gallbladders and deal with adhesions and inflammations in time to avoid damage to the bile ducts.