腹腔镜胆囊切除术中肝外胆管损伤及处理

自１９９２年１月～１９９６年１月，１２５０例病人因胆囊结石或胆囊息肉样病变在本院施行ＬＣ，胆管损伤７例（０．５６％），损伤类型包括：（１）总胆管或总肝管横断各１例；（２）总肝管部分横断２例；（３）电凝损伤总肝管及右肝管各１例；（４）钛夹钳夹右肝管１例。本组处理方法为胆管修补、胆管对端吻合及空肠Ｒｏｕｘ－Ｙ吻合术。本文认为术者操作经验不足、不适当的止血操作、胆囊病变因素及解剖不清是导致胆管损伤的原因。胆管损伤最重要的仍然是术中发现及时处理，则预后良好。

The extrahepatic binary tract injuries during laparoscopic cholecystectomy and its management

In this report, 1 250 patients suffering from gallbladder stones or polypus underwent laparoscopic cholesystectomy from January 1992 to January 1996. Iatrogenic bile duct injuries occurred in7 (0. 56% ) including transection of the common bile duct (CBD) in one,partial transection of the common hepatic duct in 2,cautery injury to the CBD,and the right hepatic duct one each,and wronglyclipped the right hepatic duct in one. Patients were managed by bile duct repair,end-to-end anastomosisof the bile duct,and Roux-en-Y maneuver. Most injuries were caused by malpractice,mass cautery,especially when there is abnormality in the bile duct system and severe inflammatory gallbladder.Immedi ate repair and management is essential for good prognosis.