腹腔镜胆囊切除术高位胆管损伤的预防及处理

目的探讨腹腔镜胆囊切除术中高位胆管损伤的原因、预防及处理方法。方法对2009年1月至2014年1月我科收治外院转入的16例腹腔镜胆囊切除术后胆管损伤的病例和同期我科腹腔镜胆囊切除术2200例无胆管损伤的临床资料进行分析。结果16例胆管损伤的部位均为肝总管横断及毁损伤，其中11例行肝总管-空肠Roux-en-Y吻合术，5例行左右肝管整形-空肠Roux-en-Y吻合术，16例病人术后恢复良好，无死亡病例。同期2200例LC术中采用“肝总管显露”确认后再行胆囊切除无一例发生胆管损伤。结论腹腔镜胆囊切除术高位胆管损伤最多见，术中“肝总管显露”是预防高位胆管损伤的可靠方法。肝总管（或左右肝管整形）-空肠Roux-en-Y吻合术是治疗高位胆管损伤最有效的手术方式。

Prevention and treatment of high bile duct injury during laparoscopic cholecystectomy

Objective To determine the causes of high bile duct injury during laparoscopic cholecystectomy and seek prevention and treatment methods. Methods From January 2009 to January 2014, the clinical data were analyzed for 16 cases of bile duct injury after laparoscopic cholecystectomy transferred from other hospitals and 2200 cases without bile duct injury from our hospital. Results All 16 cases had high bile duct transection injury and damage. And the procedures included common hepatic duct-jejunal Roux-en-Y anastomosis （n = 11） and left and right hepatic duct shaping-jejunal Roux-en-Y anastomosis （n= 5）, Postoperative recovery was all excellent without mortality. And no bile duct injury occurred among 2200 cases of laparoscopic cholecystectomy with common hepatic duct exploration. Conclusions High bile duct injury is common in clinical practice. And common hepatic duct exploration is essential for preventing high bile duct injury during laparoscopic cholecystectomy. Common hepatic duct （or left and right hepatic duct plastic） and Roux-en-Y choledchojejunostomy is the most effective surgical approach.