腹腔镜胆囊切除术胆道损伤的临床分析

目的 总结腹腔镜胆囊切除术胆道损伤的原因、预防措施、诊断及处理方法.方法 回顾分析我院从2008年1月～2013年1月处理的14例腹腔镜胆囊切除术胆道损伤的临床资料.结果 在14例患者中,A型（3例）经闭合离断的小胆管＋腹腔引流术治疗,C型（1例）和D型（5例）经肝胆管的修补＋T管引流术＋腹腔引流术治疗,E1型（3例）和E3型（1例）经肝管-空肠Roux-en-Y吻合术＋腹腔引流术治疗,E4型（1例）经融合左右肝管后再行的肝管-空肠Roux-en-Y吻合术＋腹腔引流术治疗.14例患者术后随访6～60月,均恢复良好.结论 胆道损伤是腹腔镜胆囊切除术的严重并发症,我们在了解其主要原因的同时应尽力避免损伤,一旦出现需及时正确处理,以达到满意的预后.

Clinical analysis of 14 cases of bile duct injury of laparoscopic cholecystectomy

Objective To summarize the reasons,the prevention measures,the diagnosis and the treatment methods for bile duct injury of laparoscopic cholecystectomy.Methods Retrospectively analyzed 14 cases of bile duct injury of laparoscopic cholecystectomy by our dealing between 2008.1 ～ 2013.1.Results In those cases,the type A injuries （3 cases） were cured by closing small bile duct and abdominal cavity drainage.The type C injury （1 case） and the type D injuries （5 cases） were cured by the hepatic duct repair and abdominal cavity drainage.The type E1 injuries （3 cases） and the type E3 injuries （1 case） were cured by a Roux-en-Y hepaticojejunostomy and abdominal cavity drainage.The type E4 injury （1 case） was cured by a Roux-en-Y hepaticojejunostomy and abdominal cavity drainage after the left and right hepatic duct arthrodesis.All of 14 patients recovered well during postoperative fo llowup for 6 ～ 60 months.Conclusion Biliary injury is a severe complication of laparoscopic cholecystectomy.We should be to avoid bile duct injury as we know its primary cause.Once appear,it should be timely treatment in order to achieve satisfactory outcomes.