腹腔镜胆囊切除术中胆囊管的处理体会

目的探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy，Lc）中胆囊管的处理方法。方法1997年1月-2005年12月，我院行3100例LC，对不同类型的胆囊管分别采取不同的处理方法：常规中号钛夹处理胆囊管2387例（77．0％），大号钛夹法93例（3．0％），可吸收夹法62例（2．0％），丝线结扎法155例（5．0％），阶梯钛夹法217例（7．0％），圈套器处理法184例（5．9％），因局部炎症较重未找到胆囊管者实施特殊处理2例（0．1％）。结果术后发生胆囊管胆汁漏4例（0．1％），留置腹腔引流管引流，辅以内镜逆行胰胆管造影，分别行鼻胆管引流及内支架引流3周后胆管造影，未见胆汁明显外溢及胆管扩张后拔出引流管，全部患者治愈。结论LC中根据不同胆囊管类型，采取个体化处理方案可减少胆管损伤、胆汁漏等并发症，提高手术成功率。

Experience on the management of the cystic duct during laparoscopic cholecystectomy

Objective To investigate appropriate operative methods of the cystic duct during laparoscopic cholecystectomy (LC). Methods There were 3 100 cases of LC performed in this hospital from January 1997 to December 2005. Different operative methods of the cystic duct were utilized based on different types of the cystic duct, including routine middle-sized titanic clipping in 2 387 cases (77.0%), large-sized titanic clipping in 93 cases (3.0%), absorbable clipping in 62 cases (2.0%), silk suture ligation in 155 cases (5.0%), overlapped titanic clipping in 217 cases (7.0%), and snare ligation in 184 cases (5.9%). Special management of the cystic duct was carried out in 2 cases (0.1%) because of severe local inflammation. Results Bile leakage occurred in 4 cases (0.1%) postoperatively. Abdominal drainage associated with endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic nasobiliary drainage (ENBD) or endoprosthesis drainage was given for 3 weeks. Cholangiography showed neither obvious bile leakage nor cholangiectasis. Conclusions Application of individualized management of the cystic duct during laparoscopic cholecystectomy can lower the incidence of complications and increase the success rate of operation.