腹腔镜下医源性胆管损伤的原因及对策探讨

目的：探讨腹腔镜胆囊切除术（LC）中胆管损伤的原因、处理方法及预防措施。方法：回顾分析12849例LC术术中胆管损伤的35例（0．28％）患者临床资料。结果：35例胆管损伤，术中发现29例（82．86％）。损伤类型为：高位胆管损伤3例，胆总管横断7例，右肝管横断4例、电灼伤2例，肝总管电灼伤4例，胆囊管拔断1例，胆囊管与胆总管交汇处撕裂4例，迷走肝管及副肝管损伤10例。结论：腹腔镜下胆管损伤的原因是多方面的，注重胆囊Calot三角区的操作技巧及复杂胆囊的对策，可大大减少胆管损伤的发生；对于胆管损伤应争取术中尽早发现，适时恰当处理。

Discussion of causes and treatment of iatrogenic bile duct injury in laparoscopic cholecystectomy

Objective To discuss the causes,treatment and preventive measures of iatrogenic bile duct injury in laparoscopic cholecystectomy(LC).Method The causes of 35 cases with bile duct injury among 12 849 patients received LC form Nov.1992 to Dec.2008 were analyzed retrospectively.Results Twenty-nine cases were recognized during operation,6 were recognized after operation.Types of injuries: 3 from high bile duct,7 from transverse injury of common bile duct,4 from transverse injury of right hepatic duct,2 from heat injury of right hepatic duct,4 from heat injury of common hepatic duct,1 from pull off of cystic duct,4 from laceration of intersection of cystic duct and common bile duct,10 from aberrant bile duct and tiny subsidiary hepatic duct.Conclusion There are many reasons for bile duct injury.Paying attention to operation skills of gallbladder Calot triangle and counter measures for complex gallbladder,could substantially reduce the incidence of bile duct injury.For bile duct injury during operation should seek early reorganization,appropriate and timely processing.