复杂类型腹腔镜胆囊切除术中胆道损伤的预防与诊断

The Role of Laparoscopic Ultrasonography in the Prevention and Diagnosis of Bile Duct Injury during Complicated Laparoscopic Cholecystectomy.

目的:介绍腹腔镜超声(LUS)在避免复杂类型的腹腔镜胆囊切除术(LC)中胆道损伤的作用。方法:177例LC因胆囊管真实性难以确定、三角区粘连或炎症、急性或萎缩性胆囊炎、可疑的胆道损伤等被界定为复杂的LC,并借助LUS显示的肝外胆管与胆囊壶腹、胆囊管之间的解剖关系施行LC。结果:在LUS辅助下顺利完成151例复杂的LC,另26例病人因LUS提示潜在胆道损伤危险及疑有胆道损伤而转为开腹。结论:通过LUS显示的肝外胆管及在术野中胆囊管、胆囊壶腹的参照下,术者可了解肝外胆系诸结构之间的解剖关系,由此避免胆道损伤。

Objective:To elucidate the role of laparoscopic ultrasonography(LUS)in the prevention and diagnosis of bile duct injury(BDI)during complicated laparoscopic cholecystectomy(LC).Methods:One hundred and seventy-seven cases of LC were defined as complicated ones in the presence of exposed but identified cystic duct,adhesion or inflammation in the Calot triangle,acute cholecystitis,atrophic gallbladder or suspected BDI.LUS was performed to scan the extrahepatic bile duct.LC was then carried out with the demonstration of LUS-indicated anatomic relationship between the cystic duct,cystic infundibulum and extrahepatic bile duct.Results:Under the guidance of LUS,151cases of LC were successfully accomplished,and26cases were timely converted to open cholecystectomy.Conclusions:With the aid of LUS,the extrahepatic bile duct is located the anatomic relationship between the cystic infundibulum,cystic duct and extrahepatic bile duct clarified,and the operators are thus guided to avoid BDI.