"推拉牵引-放松归位-反复确认"技术在预防腹腔镜胆囊切除术中胆道损伤的临床价值

目的 探讨"推拉牵引-放松归位-反复确认"技术在腹腔镜胆囊切除术(1aparoscopic cholecystectomy,LC)中预防胆道损伤的临床价值.方法 2001年3月至2009年8月,笔者应用此项技术完成LC 4800例.每例患者均采用"推拉牵引"显露三角区的结构,"放松归位"恢复胆囊管、肝总管和胆总管的生理位置,"反复确认"多次明确胆囊管、肝总管和胆总管的关系后再离断胆囊管.结果 全组患者无胆道损伤发生;118例分别因胆囊Calot三角结构识别困难、胆管结石、胆囊癌和胆囊一十二指肠内瘘转开腹手术.结论 "推拉牵引-放松归位-反复确认"技术能有效的预防LC术中胆管损伤,方法简单,容易掌握,值得推广.

Abstract：

Objective To study the value of the technique of "Push-pull traction-relax homingrepeatedly confirmed" in the prevention of bile duct injury in LC. Methods From March 2001-August 2009, we applied this technique in 4800 cases of LC. The technique of "Push-pull traction" showed the structures of in the Calot's triangle. The technique of "relax homing" was to restore the cystic duct,hepatic duct and common bile duct to their original anatomical positions. The technique of "repeatedly confirmed" repeatedly identified the positions of the cystic duct, the common hepatic duct and the common bile duct. Results There was no bile duct injury. Conversion to open surgery happened in 118patients due to difficulties in identifying the Calot's triangle structures, bile duct stones, gallbladder cancer, and gallbladder-duodenal fistula. Conclusions The "Push-pull traction-relax homing-repeatedly confirmed" technique could effectively prevent bile duct injury in LC. The method is simple, easy to master and worthy of promotion.

The clinical value of " Push-pull traction-relax homing-Repeatedly confirmed" in the prevention of bile duct injury in LC

Objective To study the value of the technique of "Push-pull traction-relax homingrepeatedly confirmed" in the prevention of bile duct injury in LC. Methods From March 2001-August 2009, we applied this technique in 4800 cases of LC. The technique of "Push-pull traction" showed the structures of in the Calot's triangle. The technique of "relax homing" was to restore the cystic duct,hepatic duct and common bile duct to their original anatomical positions. The technique of "repeatedly confirmed" repeatedly identified the positions of the cystic duct, the common hepatic duct and the common bile duct. Results There was no bile duct injury. Conversion to open surgery happened in 118patients due to difficulties in identifying the Calot's triangle structures, bile duct stones, gallbladder cancer, and gallbladder-duodenal fistula. Conclusions The "Push-pull traction-relax homing-repeatedly confirmed" technique could effectively prevent bile duct injury in LC. The method is simple, easy to master and worthy of promotion.