腹腔镜胆囊切除术肝外胆管损伤的防治

THE PREVENTION OF BIL E DUCT INJURY DURING L APAROSCOPIC CHOL ECYSTECTOMY

目的 研究腹腔镜胆囊切除术中预防肝外胆管损伤的有效措施。方法 分析我院近 10年行腹腔镜胆囊切除术10 80 0例 ,其中肝外胆管损伤 8例 ,损伤率 0 .0 8% ,以肝外胆管横断伤最多见 6例 ,其余电灼伤和钳闭坏死各 1例。 8例损伤均发生在开展腹腔镜前 5年的 5 0 0 0例中 ,后 5年 5 80 0例 L C未发生肝外胆管损伤。结果 8例肝外胆管损伤均行胆肠 Roux-en- Y吻合治愈。结论 良好显露 Calot三角 ,靠胆囊钝性分开 Calot三角 ,认准胆囊壶腹与胆囊管交汇部并游离出其延伸段是确认胆囊管的可行方法 ,此时 ,多能辨认清肝总管、胆总管、胆囊管、胆囊壶腹即“三管一壶腹”的相互解剖关系 。

Objective Accidental extrahepatic bile duct injuries may occur in laparoscopic cholecystectom y(L C) .The prevention measures were investigated in this report.Methods The study were based on retrospective review of 8cases ex- trahepatic bile duct injuries within past 10 years out of 10 80 0 L C in our unit from Sep.1992 to Feb.2 0 0 2 . Results It was shown that the rate of extrahepatic bile duct injuries was 0 .0 8% in this group.And all of patients with extrahepatic bile duct injuries occurred in former 5 years from Sep.1992 to Sep.1998out of form er 5 80 0 cases L C.Six of them were transecting in- jury of extrahepatic bile duct,two of them were induced by titanium clip or electric coagulation thermal injury.However,there were no occur of extrahepatic bile duct injuries in later 5 years from Sep.1998to Feb.2 0 0 2 outof later 5 0 0 0 cases L C.Conclu- sion Tactics to avoid such accident were sum med as follows:properly exposing the Calot's triangle,carefully disecting the connecting site of cystic am pulla and cystic duct,carefully recognition and verification of relations of cystic duct,common bile duct,hepatic bile duct and cystic ampulla.