胆管端-端吻合治疗腹腔镜下胆囊切除术中 胆道损伤的疗效

目的 评估胆道端-端吻合术与胆管空肠Roux-en-Y吻合术、胆道壁横行修补术治疗胆囊切除术中胆道损伤的临床价值。方法 回顾性分析2000年1月~2013年12月重庆地区3家肝胆外科中心的87例胆囊切除术中胆道损伤的患者。18例行缺损胆道壁横行修补术的设为A组，32例行胆管空肠Roux-en-Y式吻合术的设为B组，37例行胆管端-端吻合治疗的设为C组；记录三组患者年龄、性别、原发疾病（胆囊结石/胆囊息肉）、胆总管直径及手术时机；比较三组手术时长、总住院时间、术后胆道狭窄、胆管炎、出血及胆漏发生情况。结果 C组患者平均手术时间为（119.24±43.61）min，多于A组的（101.23±32.11）min，但差异无统计学意义（P＞0.05）；C组患者平均手术时间少于B组（119.24±43.61）min vs（175.56±41.52）min]，差异具有统计学意义（P＜0.05）；三组术后胆管狭窄、胆汁漏情况比较，差异无统计学意义（P＞0.05）；B组患者术后胆管炎发生率为21.88%，高于C组的2.70%，差异具有统计学意义（P＜0.05）；C组患者总住院时间为（11.45±5.32）d，多于A组的（9.52±4.13）d，但差异无统计学意义（P＞0.05）；C组总住院时间少于B组（11.45±5.32）d vs（17.71±5.27）d]，差异具有统计学意义（P＜0.05）。结论 胆管损伤采用胆管端-端吻合术手术时间短，患者总住院时间少，术后胆管炎发生率低，不增加术后胆管狭窄及胆汁漏的风险，治疗胆囊切除术中胆道损伤效果较好。

Efficacy of Bile Duct End-to-end Anastomosis for Biliary Tract Injury during Laparoscopic Cholecystectomy

Abstract:Objective To evaluate the clinical value of biliary end-to-end anastomosis and bile duct jejunum Roux-en-Y anastomosis and biliary wall transverse repair in the treatment of biliary tract injury during cholecystectomy.Methods A retrospective analysis of 87 patients with biliary tract injury during cholecystectomy at three hepatobiliary surgery centers in Chongqing from January 2000 to December 2013. 18 cases of transverse biliary wall repair were performed in group A,32 cases of bile duct jejunum Roux-en-Y anastomosis were set as group B, and 37 cases of end-to-end anastomosis of bile duct were set as group C; The age, gender, primary disease (choledocholithiasis/choledochal polyps), common bile duct diameter, and timing of surgery were compared between the three groups. The duration of surgery, total hospital stay, postoperative biliary stricture, cholangitis, hemorrhage, and bile leakage were compared.Results The average operation time of group C was (119.24±43.61) minutes, which was more than that of group A（101.23±32.11）min, but the difference was not statistically significant (P>0.05). The average operation time of group C was less than that of group B（119.24±43.61）min vs（175.56±41.52）min], the difference was statistically significant(P<0.05); three groups of postoperative bile ducts there was no significant difference in stenosis and bile leakage (P>0.05). The incidence of postoperative cholangitis in group B was 21.88%,which wsa higher than that in group C 2.70%,the difference was statistically significant (P<0.05). The total hospital stay in group C was （11.45±5.32）d,which was more than that in group A（9.52±4.13）d, but the difference was not statistically significant (P>0.05). The total hospital stay in group C was less than that in group B（11.45±5.32）d vs（17.71±5.27）d],the difference was statistically significant(P<0.05).Conclusion Biliary duct injury with biliary end-to-end anastomosis is short, the total hospital stay is small, the incidence of postoperative cholangitis is low, and the risk of postoperative bile duct stricture and biliary leakage is not increased. The treatment of biliary tract injury is better in the treatment of cholecystectomy.