腹腔镜胆囊切除术胆管并发症的防治

目的 :探讨腹腔镜胆囊切除术中避免胆道损伤的有效方法。方法 :回顾性分析 1 996～ 2 0 0 2年行腹腔镜胆囊切除的临床资料。其中胆道损伤 9例 ,包括胆总管横断 2例 ,胆总管电灼伤 1例 ,胆总管夹闭 2例 ,胆囊管残端漏 1例 ,胆囊床损伤或胆囊迷走胆管损伤 3例。胆总管损伤患者均行一期手术 ;胆囊床损伤或胆囊迷走胆管损伤的患者行穿刺抽液或置管引流治愈。结果 :本组患者 1例因发生胆肠吻合口狭窄而再次手术 ,其它患者恢复顺利。结论 :严格规范的操作 ,胆囊三角良好的显露 ,辨清肝总管、胆总管和胆囊管之间的关系 ,正确处理胆囊床和胆囊管是避免肝外胆管损伤和预防胆漏的关键。

The prevention and treatment of bile duct injury in laparoscopic cholecystectomy

Objective:To study the prevention of bile duct injury during laparoscopic cholecystectomy.Methods:Retrospectively analysed the clinical data of patients undergone laparoscopic cholecystectomy during 1996 2002.9 cases had bile duct injury.Among them 2 cases were transective injury of common bile duct,1 cauterization of common bile duct,2 clip of common bile duct,1 cystic duct bile leakage,and 3 gallbladder bed injury.All patients of common bile injury underwent one stage operative repair.The others recorvered by drainage.Results:One patient was undergone reoperation because of narrow anastomosis.The others were cured smoothly.Conclusions:The operative rule should be strictly obedient.Tactics to avoid such accident were summed as the following:properly exposing the Calot's triangle,recognization and verification of relation of hepatic bile duct,common bile duct and cystic duct,properly dealing with gallbladder bed and cystic duct.