腹腔镜胆囊切除术术中医源性胆管损伤的防治策略

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)术中减少胆管损伤的策略,以提高手术安全性。方法:回顾分析2003年6月至2008年6月我院行LC286例患者的临床资料。结果:278例成功完成手术,中转开腹8例,占2.80%。平均手术时间(60±30)min,术后第2天下床活动,并开始进食。发生胆漏1例;胆管损伤2例,约占0.70%,1例术中发现,经手术治疗痊愈,另1例转入上级医院,余无其他严重并发症发生。结论:胆管损伤的预防重于治疗,只有掌握扎实的解剖知识、熟练的腹腔镜技术和适时的中转开腹,才能不断减少胆道损伤。

Prevention and treatment of iatrogenic bile duct injury in laparoscopic cholecystectomy

Objective:To investigate how to reduce the bile duct injury in laparoscopic cholecystectomy (LC) to improve the safety of surgery.Methods:The clinical data of 286 cases undergone LC in our hospital from Jun.2003 to Jun.2008 were retrospectively analyzed.Results:The mean operative time was (60±30)min,and 8 cases were converted to open surgery,which accounted 2.80%.Patients could get out of bed and take food on the second day after operation.Bile leakage occurred in one case.Bile duct injury were found in two cases,which accounted 0.70%.One of bile duct injury was found during surgery and treated operatively,and the other was transferred to superior hospital and healed after treatment.There were no other serious complications.Conclusions:Prevention is more important than treatment for bile duct injury.In order to reduce bile duct injury,we should master anatomy,laparoscopic technique and indication of laparotomy.