腹腔镜胆囊切除术中右侧副肝管损伤的处理

目的 总结腹腔镜胆囊切除术中右侧副肝管损伤的诊断、预防和处理经验.方法 回顾性分析8例腹腔镜胆囊切除术中右侧副肝管损伤的诊治情况.结果 8例右侧副肝管损伤病例中,5例为术中发现.3例为术后发现,处理方法 :5例副肝管直径小于3.0mm者予以结扎;1例副肝管直径为5.0mm者予以重建并支撑引流半年以上;1例副肝管直径为3.0mm,但近端与邻近肝叶胆管有交通胆管存在,亦予以结扎.结扎及重建的7例患者经6个月至5年随访,预后良好.另1例术中未及时发现和正确处理的副肝管直径为3.5咖的患者术后发生了严重的胆漏和感染等并发症,历经3次引流手术,半年后治愈.全组无死亡病例.结论 腹腔镜胆囊切除术中必须严格遵守正确的操作规程,警惕副肝管的存在,避免损伤,若发生副肝管损伤,应中转开腹,及时发现和正确处理是获得良好效果的关键.

Management of right accessory hepatic duct injury during laparoscopic cholecystectomy

Objective To summarize the experience in diagnosis,prention and management of right accessory hepatic duct(AHD)injury during laparoscopic cholecystectomy(LC).Method The clini-cal data of 8 patients with AHD injury during LC diagnosed and managed retrospectively analyzed. Results Of the 8 patients, 5 patients were found during LC,3 patients were found after LC.Management were ad follow:5 patients with the diameter of the AHD smaller than 3.0 mm were ligated,1 patient with the diameter of 5.0 mm were reconstructed,1 patient with the diameter of 3.0 mm,but the AHD connected with other bile duct in vicinal epaticlobes,were ligated.These 7 patients,with the injured AHD ligated or re-constructed,were followed up for 6 months to 5 years and showed good results.The another who did not be found during LC and not be managed appropriately,arose serious bile leakage and infection for a long time,underwent drainage operations for 3 times,cured after haft year.No death in all patients.Conclusions Correct operative rules should be obeyed strictly in LC,and keep the exist of AHD under close guard,if AHD injury occurred,LC should turn to open surgery immediately,early finding of the injury and managing appropriately is the key to achieve successful result.