13例腹腔镜胆囊切除术胆管损伤的回顾分析

Retrospective analysis of 13 patients with bile duct injury during laparoscopic cholecystectomy

目的总结分析腹腔镜胆囊切除术(LC)胆管损伤的原因、预防、诊断及治疗。方法回顾分析厦门大学附属福州第二医院2003年1月—2014年1月收治的13例LC胆管损伤患者的临床资料,探讨分析胆管损伤的类型、原因及诊治方法。结果因肝外胆管解剖判断不清,术中判断失误,误将胆总管横断6例,肝总管撕裂2例,胆总管不全夹闭3例,超声刀电灼伤狭窄2例。结论胆管损伤是LC的严重并发症,需严格选择病例,且术者应在有腹腔镜技术培训、临床经验的基础上开展手术,并高度重视胆管损伤的严重性,掌握肝外胆管变异类型、术中解剖判断及应变能力、胆管损伤诊治方法,一旦发生胆管损伤,能及时正确处理达到满意预后。

Objective To analyze the causes,prevention,diagnosis and treatment of patients with bile duct injury during laparoscopic cholecystectomy( LC). Methods A retrospective analysis of 13 patients with bile duct injury during laparoscopic cholecystectomy from January 2003 to January 2014 in the Second Hospital of Fuzhou Affiliated Xiamen University were made,the types and causes,diagnosis and treatment of bile duct injury during LC were explored. Results There were 6 patients with common bile duct transection mistakenly,2 patients with hepatic duct tearmistakenly,3 patients withincomplete occlusion of the common bile duct,2 patients with burns and stenosis forusing ultrasonic scalpel,because of unclear extrahepatic biliary anatomy judgment and misjudgment during surgery. Conclusion Bile duct injury is a serious complication of LC,so the patients should be selected for strict selection to carry out LC,and laparoscopic surgeon operator should have technical training and clinical experience,at the same time should attach great importance to the severity of bile duct injury,and master extrahepatic biliary variation types,anatomic judgment and adaptability,diagnosis and treatment of bile duct injury,can take measures timely and correctly when bile duct injury.