腹腔镜胆囊切除术中胆囊管变异的认识与处理

目的:探讨腹腔镜胆囊切除术中认识与处理胆囊管变异的方法与手术技巧。方法:回顾分析2010年8月至2012年8月腹腔镜胆囊切除术中发现的57例胆囊管变异患者的临床资料。术中采用分离胆囊壶腹、保持胆囊三角区空虚,明确进入胆囊唯一管道的方法辨认与切断胆囊管。结果:57例均顺利完成手术,无一例中转开腹。手术时间35⁹0 min,平均(54.01±13.87)min;术中出血量590 min,平均(54.01±13.87)min;术中出血量5⁸0 ml,平均(31.75±15.30)ml;无一例因解剖不清导致胆管损伤。术后发生胆漏1例,系胆囊管囊性扩张钛夹夹闭不全所致,术后引流1周痊愈。术后住院280 ml,平均(31.75±15.30)ml;无一例因解剖不清导致胆管损伤。术后发生胆漏1例,系胆囊管囊性扩张钛夹夹闭不全所致,术后引流1周痊愈。术后住院2⁹ d,平均(4.82±1.39)d。随访19 d,平均(4.82±1.39)d。随访1⁶个月,无并发症发生。结论:应时刻牢记胆囊管变异的可能性,术中采用分离胆囊壶腹、保持胆囊三角区空虚的原则,可有效辨认胆囊管异常结构,从而避免胆管损伤。

The identification and management of cystic duct anatomic variations during laparoscopic cholecystectomy

Objective：The aim of this study is to explore the methods and skills of identifying and managing cystic duct ana- tomic variations during laparoscopic cholecysteetomy. Methods ： The clinical data of 57 cases with cystic duct anatomic variation found during laparoscopic cholecystectomy from Aug. 2010 to Aug. 2012 were retrospectively analyzed. The procedures to prevent bile duct in- jury included separating the gallbladder ampulla from peripheral tissues, keeping Calot triangle zone empty and identifying the only duct accessing to the gallbladder. Through these procedures, the cystic ducts were cut off and then the gallbladders were removed. Results： All patients successfully underwent laparoseopic cholecystectomy without conversion to open surgery. The operative time was 35-90 min, （54.01 ~ 13.87） rain on average. The intraoperative blood loss was 5-80 ml,with the average of （31.75 ＋ 15.30） ml. No one suffered from bile duct injury because of unclear anatomy. Bile leakage occurred in one case for cystic distension of cystic duct and incomplete close of titanium clip, this complication was cured after one week drainage. Postoperative hospital stay was 2-9 d, the mean was （4.82 _＋ 1.39） d. During the follow-up of 1-6 months, no complications developed in any patients. Conclusions：Identifying cystic duct anatomic variations with correct methods is helpful to confirm these anomalous ducts and prevent iatrogenic bile duct injury. The correct methods include always keeping the possibility of cystic duct variation, separating the gallbladder ampulla from peripheral tissues and keeping Calot triangle zone empty.