冲吸钝性解剖法显露肝总管防止腹腔镜胆囊切除术中胆道损伤

目的介绍一种能有效防止腹腔镜胆囊切除术中胆道损伤的方法。方法2003年1月—2005年10月，我们采用此方法共完成腹腔镜胆囊切除术629例，每例病人切断胆囊管前常规行冲吸钝性解剖法显露肝总管，明确肝总管和胆总管后再离断胆囊管。结果本组病人无胆道损伤发生；7例转开腹手术，5例因为严重的腹腔粘连，1例因为胆肠内瘘形成，1例因为术中冰冻报告胆囊癌而转开腹行胆囊癌根治术。结论腹腔镜胆囊切除术中冲吸钝性解剖法显露肝总管能效防止术中胆道损伤，这种方法简单易学，易于推广。

Experience in laparoscopic cholecystectomy by exposing common hepatic duct using blunt dissection to prevent bile duct injury

OBJECTIVE: To introduce an effective method for preventing bile duct injury in laparoscopic cholecystectomy. METHODS: From January 2003 to October 2005, laparoscopic cholecystectomy was performed on 629 patients, 335 males and 294 females, aged 46.3 (14 - 81). The common hepatic duct was exposed by blunt dissection routinely before transecting the cystic duct. RESULTS: No bile duct injury occurred. 7 cases were converted to open procedure, 5 cases for severe abdominal adhesion, one for internal fistula of bile duct to intestinal tract, and another 1 for gall bladder cancer. 2 patients had postoperative complications, one with raw surface bleeding, and the other with incision bleeding. CONCLUSION: Exposing common hepatic duct by blunt dissection in laparoscopic cholecystectomy can prevent intraoperative bile duct injury. Such procedure is simple, easy to learn and easy to apply.