腹腔镜胆囊切除术致胆管损伤的防治(附11例分析)

Prevention and treatment of injury of bile ducts due to laparoscopic chole cystectomy:A report of 11 cases

目的 :探讨腹腔镜胆囊切除术致胆管损伤的预防和处理方法 ,强调术中预防措施的重要环节。方法 :回顾性总结我院1993年 5月～ 2 0 0 2年 3月腹腔镜胆囊切除术 180 0例 ,致胆管损伤 11例的损伤情况和特点。结果 :11例有 4例术中发现及时处理 ,7例术后发生胆汁性腹膜炎 ,再次手术 ,均顺利恢复 ,随访 1～ 5年无胆管狭窄及其它并发症。结论 :腹腔镜胆囊切除术致胆管损伤不同于开腹手术 ,有其特殊性。术中术者精心、细致操作和正确判断、辨认是防止损伤的关键 ,术中发现损伤立即修复 。

Objective:To probe into the prevention and management of injury of bile ducts induced by laparoscopic cholecystectomy,emphasizing the important procedures in the prevention.Methods:One thousand eight hundred cases who underwent laparoscope cholecystectomy from May 1993 to March 2002 in our hospital were analysed retrospectively.Eleven cases had injury of bile ducts.Results:Of all the 11 cases,4 cases of injury of bile ducts were found during operation and managed timely,7 cases developed postoperative choleperitonitis and required reoperation.All patients were followed up 1 to 5 years and no biliary ducts stegnosis or others complications occurred.Conclusions:The injury of bile ducts caused by laparoscopic chole cystectomy is different from that caused by cystectomy.Careful,precise operation and correct judgement are the key factors for the prevention of injury of bile ducts.If the injury is found during operation and managed timely,the outcome will be better.