腹腔镜胆囊切除术细小胆管损伤的诊断与处理

目的 总结腹腔镜胆囊切除术（LC）对细小胆管损伤的诊断及处理体会。方法 分析2050例LC手术中14例细小胆管损伤的情况。6例于术中发现漏胆点，予以钛夹夹闭；4例未找到渗胆点，予引流；4例术后出现胆汁性腹膜炎，其中1例剖腹探查并缝扎渗胆处，1例行腹腔探查并引流，另2例经腹壁戳孔放置多孔尿管引流。结果 14例均获痊愈，其中4例术后出现胆汁性腹膜炎者经治疗也未产生严重后果。结论 LC时细小胆管损全国各地较难避免。术中发现并及时治疗效果最好；术后发现应行剖腹探查或再次腹腔镜手术探查并予充分引流；对漏胆量少的患者经腹壁戳孔放置引流管引流是可取的方法。

DIAGNOSIS AND TREATMENT OFSMALL BILE DUCT INJURY DURING LAPAROSCOPIC CHOLECYSTECTOMY

Objective To comment the diagnosis and treatment the bile leakage from the injuried abnormal minute biliary in our laparosicopic cholecystectomy (LC) practice. Methods Fourteen cases of minute biliary duct injury in 2 050 cases of LC were studied retrospectively. Among them, 6 cases had been found the points of leakage during operation, and the points were treated by titanium nips. In 4 cases even though the bile leakage could be seen, but the points of leakage could not found, and were treated by drainage. Four cases with peritonitis, 1 needed to be explored, and treated with suture ligature, 1 was explored by laparoscopy again, another two cases were treated with multiple hole catheters to drainage of the abdominal cavities through stab wounds. Results All 14 cases recovered. Conclusion Small bile leakage in LC is almost inevitable. It is the best that the bile leakage can be discovered during operation and to be treated. If it is discovered after operation, an open or laparoscopic exploratory laparotomy and adequate drainage would be needed. In the case of small amount of leakage, catheter drainage through stab wound is feasible.