腹腔镜胆囊切除术后胆道损伤实施介入治疗的临床价值观察

目的探讨介入治疗在腹腔镜胆囊切除术（LC）后胆道损伤（BDI）中的临床价值。方法回顾性分析并总结1997年6月至2007年5月收治的24例接受介入治疗的LC术后BDI患者的临床资料。结果按刘允怡胆管损伤分类法，24患者中Ⅰ型5例、Ⅱ型11例、Ⅲ型2例、Ⅳ型6例。2例术中发现BDI并中转开腹，但分别于术后10个月和2年出现胆道感染；22例术后发现，其中13例为LC术后3—12d发现，7例为20～60d发现，2例在术后2年发现。24例患者中5例在接受介入治疗后获得治愈，19例在胆管炎和黄疸得到控制后手术治愈。其中LC术后3—12d发现的13例患者中，6例接受急诊手术，均告失败，而直接接受介入治疗的7例中3例治愈，4例在控制胆管炎和黄疸后择期手术治愈。结论LC术后BDI实施介入治疗，建立必要的胆管内支撑和通畅的胆汁引流，不仅可有效控制胆管炎，消退黄疸，获得全面的胆道树影像，有利于增加手术的安全性，甚至可以起到治愈的效果。

Interventional treatment of bile duct injury after laparoscopic cholecystectomy

Objective To investigate the value of interventional therapy in bile duct injury (BDI) due to laparoscopie cholecystectomy (LC). Methods Data of 24 BDI patients, who received interventional treatment after LC from June 1997 to May 2007, were retrospectively analyzed. Results According to Liu Yunyi criteria of BDI classification, there were 5 cases of type Ⅰ , 11 cases type Ⅱ , 2 type Ⅲ and 6 type Ⅳ. BDI was found during LC in 2 patients and the operation was switched to open cholecysteetomy, but bile duct infection was experienced 10 months and 2 years after the operation, respectively. BDI was diagnosed postoperatively in 22 patients, in which 13 eases occurred 3-12 days after LC, 7 cases 20-60 days after LC, and 2 cases 2 years after LC. Complete remission was achieved by interventional therapy in 5 patients, the other 19 patients received curative operation after control of cholangitis and jaundice. Among 13 patients who were diagnosed BDI 3-12 days after LC, 6 underwent emergency operation and failed. Of the 7 other patients who received interventional therapy, 3 were cured and the others underwent curative operation after cholangi-tis and jaundice were controlled. Conclusion Application of interventional therapy in BDI after LC can a-chieve successful bile duct support and drainage, and can obtain complete image of bile duct system, which is effective not only in control of cholangitis and jaundice for the safety of the following surgery, but also in cure of BDI.