LC术中胆道损伤的危险因素及预防分析

目的:探讨腹腔镜胆囊切除术(LC)胆管损伤的危险因素及患者的预后。方法:回顾分析4 532例腹腔镜胆囊切除术患者的临床资料,对出现胆管损伤患者相关影响因素进行单因素分析,并分析胆管损伤的独立危险因素。结果:4 532例腹腔镜胆囊切除术患者中发生术后并发胆管损伤者19例,发生率为0.42%,单因素分析结果显示观察组患者处于急性期、胆囊壁增厚、解剖变异和术者经验少的比例均明显高于对照组(P<0.05)。经回归分析,解剖变异和术者经验是发生胆管损伤的独立危险因素(P<0.05)。结论:胆管损伤是严重的LC后并发症,解剖变异和术者经验少是影响其发生的独立危险因素。     

腹腔镜胆囊切除术胆管损伤危险因素分析

目的 分析腹腔镜胆囊切除术（LC）胆管损伤的危险因素。方法 回顾性分析湖南省浏阳市人民医院1999年10月至2010年12月所行4531例LC病人的临床资料,对出现胆管损伤病人各影响因素进行χ2检验,并分析胆管损伤的独立危险因素。结果 单因素分析显示：病人性别、炎症分期、B超示胆囊壁厚度、胆囊三角解剖和术者经验与胆总管损伤有关联（P＜0.05）。多因素非条件Logistic回归分析结果显示：胆囊三角解剖和术者经验是胆管损伤的独立危险因素（P＜0.05）。结论 胆囊三角解剖和术者经验是胆管损伤的独立危险因素。     

中国腹腔镜胆囊切除胆管损伤危险因素的荟萃分析

目的:探讨中国腹腔镜胆囊切除胆管损伤的危险因素。方法:检索PubMed、EMBASE、中国知网、万方数据库、维普网数据库,收集1992—2020年公开发表的中国腹腔镜胆囊切除胆管损伤危险因素病例对照研究,使用Revman5.3进行荟萃分析,用OR值和95%CI分析结果。结果:包括20项病例对照研究,共纳入41134例患者,466例患者腹腔镜胆囊切除时发生胆管损伤,胆管损伤的发生率为1.13%。胆管损伤的危险因素包括年龄(≥40岁)、术前肝功能异常、白蛋白(<40 g/L)、胆囊壁厚度(≥4 mm)、胆囊急性炎及亚急性炎症、胆囊结石合并积液、胆囊三角解剖变异。结论:年龄(≥40岁)、胆囊壁厚度(≥4mm)、术前肝功能异常、白蛋白(<40 g/L)、胆囊急性炎及亚急性炎症、胆囊结石合并积液、胆囊三角解剖变异是腹腔镜胆囊切除胆管损伤的危险因素,需早期识别这些危险因素,提高手术的安全意识,避免胆管损伤的发生。     

LC术中预防胆管损伤的手术技巧

<正> 腹腔镜胆囊切除术(Laparoscopic Cholecystectomy,LC)的严重并发症之一是胆管损伤(Bile Duct Injury,BDI),特别是肝总管、胆总管的损伤。 作者自1991年以来实施腹腔镜胆囊切除术1200余例,未发生肝总管、胆总管损伤,现将LC术中防止胆管损伤的手术体会总结如下。 1 V形分离三角右边,牵展暴霹Calot三角     

LC胆管损伤11例临床分析

<正>腹腔镜胆囊切除术(Laparoscopic Choleoysleclomy LC)最常见的并发症为胆道损伤,总体发生率为0~2%[1]。我院自2003年9月至2009年12月开展LC 3846例,发生胆管损伤11例,发生率为0.28%,现报告如下。1临床资料1.1一般资料11例胆管损伤中男3例,女8例,年龄22~76岁,平均49岁。均为慢性结石性胆囊炎,其中8例     

LC术中预防胆管损伤的手术技巧

腹腔镜胆囊切除术（ｌａｐａｒｏｓｃｏｐｉｃｃｈｏｌｅｃｙｓｔｅｃｔｏｍｙ,简称ＬＣ）的严重并发症之一是胆管损伤,特别是肝总管、胆总管的损伤。作者自１９９１年以来实施腹腔镜胆囊切除术１３００余例,术者在施行的ＬＣ中未发生过肝总管、胆总管损伤。结合１５次...     

LC胆管损伤的会诊随感

随着腹腔镜胆囊切除术(LC)的广泛开展，胆管损伤也不断增多，自2000年以来，本人先后到外院及外地会诊，共处理LC胆管损伤14例，有的病例在所损伤医院经历了3～4次手术，效果不佳，甚至死亡。教训颇多，应予以高度注意和警惕。     

腹腔镜胆囊切除术胆管损伤及术后胆漏的临床分析

目的 分析腹腔镜胆囊切除术后胆漏及胆管损伤的原因、治疗方法及预后。方法 总结1999年1月～2005年7月7例腹腔镜术后胆漏及胆管损伤的患者，进行回顾性分析。结果 7例患者中2例迷走胆管漏，1例经腹腔引流后治愈，1例经B超引导穿刺引流后治愈；胆囊管残端漏1例，再次手术缝扎，胆总管探查取石放置T型管引流后治愈，肝总管损伤漏2例，1例用3-0可吸收线间断缝合，放置腹腔引流治愈，1例剖腹手术修补漏口，放置T型管支撑6个月；胆总管横断2例剖腹行胆总管端端吻合放置T管支撑6-7个月。术后随访1～3年，均恢复良好。结论 腹腔镜胆囊切除术后的胆漏及胆管损伤，应及时发现，正确处理。     

LC胆管损伤8例报告

目的 总结腹腔镜胆囊切除术(laparoscopic cholocystectomy,LC)中预防胆管损伤的经验.方法 回顾分析5200例LC中8例胆管损伤的临床特点、处理方法及效果.结果 术中发现5例,术后发现3例,行胆管空肠Roux-Y吻合2例,胆管修补+T管支撑引流3例,胆管对端吻合+T管支撑引流2例,B超引导下穿刺引流1例.术后无胆管狭窄发生.结论 严格掌握手术适应证、熟悉胆道解剖、熟练地掌握操作技巧是避免LC胆管损伤的关键.早期诊断和处理胆管损伤能有效降低胆管损伤的再手术率.     

腹腔镜胆囊切除术中医源性胆管损伤危险因素和防治策略

正目前,腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)已成为治疗胆囊疾病的金标准术式。但与之相关的医源性胆管损伤(iatrogenic bile duct injury,IBDI)所引发的严重远期并发症如胆管狭窄、肝脏萎缩、肝纤维化、继发性胆汁性肝硬化、门静脉高压等,严重影响着病人的生活质量和寿命。本文就LC中IBDI的危险因素及防治策略做一阐述。1 IBDI的危险因素     

Delayed presentation of bile duct injuries after laparoscopic cholecystectomy

Bile duct injury is a serious complication of laparoscopic cholecystectomy, with 50% of bile duct injuries showing a delayed presentation. We experienced four patients (one male and three female) with bile duct injuries after laparoscopic cholecystectomy performed and referred by a local practitioner. The patients' ages ranged from 34 to 63 years. Symptoms included abdominal pain, anorexia, jaundice, ascites, ileus, fever, and tarry stool. Ductal injuries were a result of electrocautery burn in two patients and biliary strictures were due to malapplication of endoclips in the remaining two. The observed bile duct injuries, confirmed by ultrasonography, computed tomography (CT) scanning, and cholangiographic studies, were successfully treated by choledochotomy with a silastic T-tube stent. To avoid bile duct injuries, laparoscopic cholecystectomy should be performed by a well trained and experienced hepatobiliary surgeon, who should ensure accurate identification of the anatomical structures of Calot's triangle, careful dissection and management of intraoperative bleeding, and a lower threshold for conversion to open surgery.     

Comparison of major bile duct injuries following laparoscopic cholecystectomy and open cholecystectomy

BACKGROUND: The mechanism and extent of major bile duct injuries following laparoscopic cholecystectomy differ from those of open cholecystectomy. METHODS: To identify differences in the demographic profile, timing of injury detection, management strategies and outcome, we undertook a retrospective review and analysis of our experience with 55 major bile duct injuries following both laparoscopic and open cholecystectomies over a period of 9 years. RESULTS: Thirty-one major bile duct injuries resulted from laparoscopic cholecystectomy (56%) and 24 of them were sustained after open cholecystectomy (44%). The median time of presentation was 7 days after laparoscopic cholecystectomy and 14 days following open cholecystectomy (P < 0.001). Twenty-eight (51%) patients had injuries recognized intraoperatively in both groups, of whom 18 patients underwent an attempt at primary repair before referral. All patients required subsequent surgical intervention. There were no differences in the clinical presentations between the two groups. However, serum alkaline phosphatase, alanine aminotransferase and aspartate aminotransferase levels were significantly higher following open cholecystectomy (P < 0.05). There was no significant difference in the level of injury between the two groups. All patients underwent surgical repair in the form of a Roux-en-Y hepaticojejunostomy (including two revision hepaticojejunostomies in each group). Surgical outcome did not differ between the groups; however, better results were seen with Bismuth grades 1 and 2 strictures compared with Bismuth grades 3 and 4 strictures for both groups (P < 0.002). CONCLUSION: Major bile duct injuries following laparoscopic cholecystectomy present earlier and with lower levels of serum alkaline phosphatase, alanine aminotransferase and aspartate aminotransferase. There does not appear to be a significant difference between the Bismuth-Strasberg grading of the strictures and the type of surgery carried out.     

腹腔镜胆囊切除术后胆道损伤的处理策略

目的 探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）术后胆道损伤时合理的处理策略.方法 回顾性分析11年间我院处理的17例LC手术后胆道损伤的临床资料,其中胆囊床小胆管损伤4例,采用缝扎或内镜下胆道引流;主要胆管部分损伤8例,采用单纯修补、内镜下引流、放置支架或胆管空肠Roux-en-Y吻合;胆总管或肝总管完全横断4例,予对端吻合或胆肠吻合;左右肝管横断1例,二期整形后行胆肠吻合.胆道再狭窄患者予内镜下扩张并置入支架,效果不佳者行胆肠吻合.结果 所有患者均无重大并发症发生,疗效满意.结论 LC手术胆道损伤重在预防,一旦损伤,需由有经验的胆道专科医生依据损伤情况选择干预方式,方能达到最好疗效.     

Major bile duct injuries after laparoscopic cholecystectomy: A tertiary center experience

Bile duct injury is a severe and potentially life-threatening complication of laparoscopic cholecystectomy. Several series have described a 0.5% to 1.4% incidence of bile duct injuries during laparoscopic cholecystectomy. The aim of this study was to report on an institutional experience with the management of complex bile duct injuries and outcome after surgical repair. Data were collected prospectively from 40 patients with bile duct injuries referred for surgical treatment to our center between April {dy1998} and December 2003. Prior to referral, 35 patients (87.5%) underwent attempts at surgical reconstruction at the primary hospital. In77.5%of the patients, complex typeE1or typeE2BDIwas found. Concomitant with bile duct injury, seven patients had vascular injuries. Roux-en-Y hepaticojejunostomy was carried out in 33 patients. In two patients, Roux-en-Y hepaticojejunostomy and vascular reconstruction were necessary. Five patients, one with primary nondiagnosed Klatskin tumor, required right hepatectomy. Two patients, both with bile duct injuries and vascular damage, died postoperatively. Because of progressive liver insufficiency, one of them was listed for high-urgency liver transplantation but died prior to intervention. At the median follow-up of 589 days, 82.5% of the patients are in excellent general condition. Seven patients have signs of chronic cholangitis. Major bile duct injuries remain a significant cause of morbidity and even death after laparoscopic cholecystectomy. Because they present a considerable surgical challenge, early referral to an experienced hepatobiliary center is recommended.     

避免腹腔镜胆囊切除术中胆管损伤的手术技巧

目的 探讨避免腹腔镜胆囊切除术（LC）中胆管损伤的方法。方法 对2014年1月至2015年12月我院收治的676例施行LC的临床资料进行回顾性分析。手术技巧包括：前哨淋巴结定位识别胆囊动脉、Rouviere沟引导定位、Calot三角360°解剖、胆囊板分离、吸引器冲洗钝性解剖、果断中转开腹等。结果 本组患者无胆管意外损伤。手术时间30～110 min,平均45 min。11例中转开腹手术,其中4例因腹腔粘连严重,2例因Mirizzi综合征,1例因胆囊结肠内瘘,4例因术中冰冻病理检查提示胆囊癌,遂中转开腹行胆囊癌根治术。术中见2例少见副肝管汇入胆囊管。术后无大出血、胆漏或再次手术等。结论 合理应用手术技巧能有效避免LC术中的胆管损伤。     

腹腔镜胆囊切除术中医源性胆管损伤的预防

腹腔镜胆囊切除术（LC）目前已定位为良性胆囊疾病的金标准手术。医源性胆管损伤（iatrogenic bile duct injury,IBDI）是其最严重的并发症之一。如发现不及时或处理不当都可能引起严重后果。因此,LC引发的胆管损伤应引起足够的重视。术者经验不足、局部粘连严重、出血、胆道解剖变异等是导致胆管损伤的主要原因。了解LC发生IBDI的风险因素,正确处理IBDI,对避免威胁病人生存质量的后果有非常重要的意义。     

Management of major bile duct injuries after laparoscopic cholecystectomy

Background: The aim of this study was to analyze the presentation, characteristics, related investigation, and treatment results of major bile duct injuries (MBDI) after laparoscopic cholecystectomy (LC).Methods: We performed a retrospective analysis of 27 patients who were treated between January 1995 and December 2002 for MBDI after LC at a single unit in a tertiary center. Major bile duct injury was defined according to the Strasberg classification. All patients underwent magnetic resonance cholangiography (MRC), percutaneous transhepatic cholangiography (PTC), or endoscopic retrograde cholangiopancreatography (ERCP) to delineate the biliary anatomy and assess the level of injury. On the basis of the cholangiographic findings, all patients underwent Roux-en-Y hepaticojejunostomy after a waiting period of 8-12 weeks.Results: A total of 29 hepaticojejunostomies were performed in 27 patients. Seventeen patients (63%) presented with biliary fistula and ascites; 10 (27%) presented with obstructive jaundice. In 14 patients (52%) the MBDI was identified during the LC. Twenty patients (74%) had undergone one or more procedure before referral. Eight patients (30%) had E1, five patients (18.5%) had E2, nine patients (33%) had E3, and five pattients (18.5%) had E4 injury. Two patients had early anastomotic stricture, for which redo hepaticojejunostomy with access loop was performed.Conclusions: Major bile duct injury after LC commonly presents with biliary fistula and ascites. High-injuries are common after LC. Hepaticojejunostomy repair yields excellent results in these cases.Presented at the First European Endoscopic Surgery Week, at the annual meeting of the European Association for Endoscopic Surgery (EAES), Glasgow, Scotland 15–18 June 2003