腹腔镜复杂胆囊切除术时预防胆道损伤的经验

目的总结有效预防腹腔镜下复杂胆囊切除术中胆道损伤的经验。方法回顾我院近十年来所开展的512例腹腔镜下复杂胆囊切除术，对其经验进行总结分析。结果腹腔镜胆囊切除术(lapamscopic cholecystectomy，LC)成功率为95．9％(491／512)，中转开腹率为4．1％(21／512)，1例LC术后发生胆囊床迷走胆管漏，经保守治疗治愈。均未发生胆道损伤或手术死亡。随访310例，时间6～24月，无一例发生胆管狭窄，继发胰腺炎4例保守治疗痊愈。结论扎实的微创外科技能、术前对手术难度的充分评估、术中显露清楚、操作细致以及果断中转开腹，是避免LC手术时胆道损伤的关键。

Prevention of Extra-hepatic Bile Ductal Injury under Difficult Laparoscopic Cholecystectomy

Objective To explore the effective method to prevent extra hepatic bile ductal Injury under difficult laparoscopic cholecystectomy(LC). Methods 512 cases of difficult LC during last 10 years were retrospectively reviewed. Results 21 cases(95.9%) converted to open surgery among the 512 cases of LC. 1 case experienced bile leakage from aberrant bile duct and cured after conservative treatment. No bile ductal injury or intra-operative death occurred. There was no occurence of bile ductal stricture within 6 to 24 months follow-up in 310 cases. 4 cases of secondary pacreatitis were cured by conservative treatment. Conclusion Skilled minimal invasive surgery, thorough preoperative evaluation, adequate intra-operative exposure, refined manipulation and prompt conversion to open surgery play the key role in preventing bile ductal injury during LC.