胆囊切除术胆管损伤的原因分析与处理

目的探讨胆囊切除术导致胆管损伤的原因及损伤后的处理方式。方法对21例胆囊切除术引起胆管损伤的损伤原因及处理方式的临床资料进行回顾性分析。结果损伤原因主要有：（1）胆囊急性炎症期进行手术8例，（2）经验不足5例，（3）Calot三角结构不清3例和解剖变异3例，（4）术中出血导致损伤2例。在处理方式上，本组有3例在术中发现胆管损伤后即时进行修复，12例在术后14d内修复，均取得良好的效果。另外6例在损伤后15d-95d之间进行修复，其中4例恢复良好，1例术后存在慢性胆管炎，死亡1例。绝大部分17例的病例采用胆管空肠Roux-en-Y吻合术，恢复良好15例。结论胆囊切除术导致的胆管损伤应由有经验的肝胆外科专科医生进行修复．早期修复是可行的，胆管空肠吻合术是首选的手术方式。

Analysis of causes of bile duct injuries during cholecystectomy and surgical management

Objective To investigate the causes of bile duct injuries during cholecystectomyand surgical management. Methods The data of 21 cases with bile duct injuries (BDI)duringcholecystectomy were analyzed retrospectively. Results The main causes of BDI were:(1)operationperformed during acute cholecystitis (n =8), (2) lack of experience (n =5), (3)uncertain of thestructure of Calot Triangle (n=3) and variable anatomical position (n=3), and (4) intra-operationbleeding (n=2). Operative repair was performed immediate...