腹腔镜下处理腹腔镜胆囊切除术胆道和胃肠道损伤

目的评价腹腔镜下处理腹腔镜胆囊切除术后胆道和胃肠道损伤. 方法 1991年10月～2002年12月,完成连续无选择腹腔镜胆囊切除术和腹腔镜胆囊切除联合胆道探查9 016例,其中发生胆道损伤14例(0.15%),胃肠道损伤3例(0.03%).其中1例胆管横断伤、10例胆管部分损伤、1例胃损伤、2例十二指肠损伤均在腹腔镜下修补. 结果 1例胆道损伤腹腔镜下修补术后胆漏,1年后发生胆道狭窄,其余均痊愈出院. 结论胆道部分损伤及胃肠道损伤可在腹腔镜下处理,对于胆道横断伤的腹腔镜处理,需进一步探讨.

Laparoscopic management of bile duct and gastrointestinal injury during laparoscopic cholecystectomy

Objective To evaluate the efficacy of laparoscopic management for bile duct and gastrointestinal injuries during laparoscopic cholecystectomy. Methods Laparoscopic cholecystectomy with or without laparoscopic bile duct exploration was attempted in 9 016 consecutive patients between October 1991 and December 2002. We experienced 14 cases of bile duct injuries (0.15%) and 3 cases of gastrointestinal injuries (0.03%). One patient with circumferential injury and 10 patients with partial laceration injuries of the bile duct underwent a laparoscopic simple closure. One gastric and two duodenal injuries were successfully repaired under laparoscope. Results Expect 1 patient suffered postoperative biliary leakage and bile duct stricture 1 year after the surgery, all the patients were cured and discharged from the hospital. Conclusions Partial laceration injuries of the bile duct or gastrointestinal injuries could be treated with a laparoscopic technique. Concerning laparoscopic management of circumferential bile duct injuries, further study should be taken.