腹腔镜复杂胆囊切除术中预防医源性胆道损伤的临床体会

Clinical experience of prevention of iatrogenic bile duct injury in laparoscopic complex cholecystectomy

目的:总结腹腔镜复杂胆囊切除的术式选择及预防医源性胆道损伤的临床经验。方法:回顾分析2020年9月至2021年10月为94例患者行腹腔镜复杂胆囊切除术的临床资料,并总结其手术方法与术中处理技巧。患者19~84岁,平均(54.1±14.0)岁,急性化脓性胆囊炎24例,胆囊萎缩17例,充满型胆囊结石12例,24例有腹部手术史,坏疽性胆囊炎6例,胆囊穿孔5例,Mirizzi综合征2例,胆道解剖结构异常1例,冰冻样Calot三角40例。结果:术中发现患者Calot三角均粘连严重。90例患者成功完成腹腔镜手术,4例中转开腹,无其他术中副损伤发生。手术时间15~210 min,平均(55.1±30.5)min;术中出血量0~2100 mL,中位数20(10,30)mL;住院2~24 d,平均(6.1±3.3)d。术后均无胆漏、医源性胆道损伤等并发症发生。结论:术者具备丰富经验、术中正确处理可更好地预防医源性胆道损伤的发生。

Objective:To summarize the clinical experience in the selection of laparoscopic complex cholecystectomy and prevention of iatrogenic bile duct injury.Methods:The clinical data of 94 patients who underwent laparoscopic complex cholecystectomy from Sep.2020 to Oct.2021 were retrospectively analyzed,and the surgical methods and the corresponding treatment skills during the operation were summarized.Patients were 19-84 years old,with an average of(54.1±14.0)years old.Among them,24 cases were acute suppurative cholecystitis,17 cases were gallbladder atrophy,12 cases were filled type cholecystolithiasis,24 cases had previous abdominal surgery history,6 cases were gangrenous cholecystitis,5 cases were gallbladder perforation,2 cases were Mirizzi syndrome,1 case was biliary anatomical structure abnormalities,40 cases were frozen Calot triangle.Results:All patients had severe adhesion of Calot triangle under direct vision.The 90 patients were successfully operated,4 cases were converted to laparotomy without other intraoperative vice-damage.The operation time was 15-210 min,with an average of(55.1±30.5)min;the intraoperative blood loss was 0-2100 mL,and the median was 20(10,30)mL;the hospital stay was 2-24 d,with an average of(6.1±3.3)d.There was no postoperative biliary fistula,iatrogenic bile duct injury or other complications.Conclusions:The rich experience of the surgeon and the correct handling of the corresponding situation can better prevent iatrogenic bile duct injury.