胆囊切除术中副肝管的发现与处理

目的 探讨胆囊切除术中副肝管的发现与处理办法。方法 回顾性分析我科2003／2004手术中及手术后发现的副肝管病例共6例的临床资料，其中1例未缝合胆囊床，放置腹腔，温氏孔（Winslow孔）引流管，术后有漏胆现象，逐日减少，考虑为hasehka管，其余5例于术中发现汇合于胆囊颈管的副肝管，于汇合部前方处理胆囊颈管．从而避免了胆管损伤。结果 1例Luschda管患者术后漏胆逐日减少，其余5例均无特殊，6例均治愈出院。结论 胆囊切除术中应重视Calot三角区域的解剖，一定要辨清三胆关系。剥离胆囊脱离胆囊床时注意观察有无副肝管并常规缝合胆囊床。越近胆囊管副肝管发生率越高。胆囊切下后温氏孔应常规放置引流管。

Discovery and treatment of the accessory hepatic duct in cholecystectomy

Aim To discover and treat the accessory hepatic duct in cholecystectomy.Methods The clinical data of 6 cases were analyzed, who stayed in our department from 2003 to 2004 and suffered from accessory hepatic duct during and after operation were reviewed. In one case the cholecyst bed was not sewn up, but a Winslow pipe was placed. After operation, the bile leakage was found, but it was reduced gradually. In other five cases,the accessory hepatic duct to combine with cystic duct were found, the cystic duct beyond the combination was cut to avoid hurting the bile duct.Results In one case that had Luschka duct when postcholecystectomic, the bile leakage reduced gradually.The other five cases recovered. Six cases were cured and discharged from hospital.Conclusion We should pay great attention to the anatomy of cholecyst triangle, and we must identify the relationship between the three canals. It is important to observe whether there is accessory hepatic duct while stripping the cholecyst from the cholecyst bed and the cholecyst bed is sewn up by common practice.The closer it is to cystic duct, the higher incidence of accessory hepatic duct there is.After postcholecystectomic is performed, a pipe shall be placed in the Winslow hole.