腹腔镜胆囊切除胆道损伤后再手术时机和选择

目的探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）致胆管损伤（bileduct injury,BDI）的手术时机、手术方式及技巧。方法回顾性分析我院收治的21例接受手术治疗的LC后胆管损伤病例,胆管损伤Ⅰ型2例、Ⅱ型11例、Ⅲ型仅2例、Ⅳ型6例。结果本组1例术中Ⅱ型胆总管损伤,经中转开腹行胆总管修补和T管引流而治愈,术后2例出现胆漏,经充分引流后自愈。术后随访1.5～5年,无胆道狭窄及胆管炎发作。其余20例均接受了毁损的胆管切除、肝总管或左右肝管的胆肠吻合术,并获得治愈。结论LC致BDI手术仍是BDI的首选治疗。把握手术时机,避免盲目手术,及早选择有经验的专科肝胆外科医生恰当处理是提高治愈率的关键。

Re-operative timing and choice of operative treatment for bile duct injury during laparoscopic cholecystectomy

Objective To investigate experience of operative treatment for bile duct injury （BDI） during laparoscopic choleeysteetomy （LC）. Methods 21 cases were retrospectively analyzed, who suffered from BDI during LC and underwent operative treatment. Among 21 cases, 2 cases suffered from type Ⅰ BDI, Ⅱ cases type Ⅱ , 2 cases type Ⅲ , and 6 cases type Ⅳ. Results One patient successfully underwent primary common bile duct repair and T-tube drainage by conversion to open procedure. 20 cases were cured after undergoing resection of impaired dile duet and hepaticojejunostomy or cholangiojejunostomy. One case occurred type Ⅱ BDI during operation. Via transferred to open abdominal surgery, conmman bile duct repair and T tube drainage, the patient was cured. Postoperative biliary leakage was found in two cases and the patients were cured after enough drainage. With follow-up for 1.5-5 year, no biliary tract stenosis and cholangitis were found in this group. Conclusion The operative treatment is still the first choice for treating BDI during LC. But it is very necessary to grasp re-operative timing and choice of operative treatment, avoid blind operation, accept the appropriate, ordered treatment by experienced hepatobiliary surgeons.