腹腔镜胆囊切除术并胆管损伤的诊断治疗

目的 探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)胆管损伤的原因、诊断和治疗.方法 回顾性分析近7年来行腹腔镜胆囊切除术1656例患者的临床资料.结果 胆囊息肉274例,胆囊结石伴急性胆囊炎168例,胆囊结石伴慢性胆囊炎1214例.共发生胆管损伤15例(0.91%),术中发现8例,术后早期发现7例.术中诊断主要依据手术野胆汁渗出或发现有2个胆管残端;术后诊断主要依靠临床症状、体征及影像学检查.1例患者行胆管壁缝合修补+T管支撑引流,4例患者行胆管端端吻合术,其中1例行胆管端端吻合加内支架支撑术后发生胆瘘而行再次开腹胆肠Roux-en-Y吻合术,其余10例患者均行胆肠Roux-en-Y吻合术,均痊愈出院,愈后良好.结论 腹腔镜胆囊切除术胆管损伤与病因无关,术中及术后早期发现及恰当的处理,愈合良好.胆肠Roux-en-Y吻合术是胆管损伤最主要的修复术式.

Diagnosis and treatment of bile duct injuries associated with laparoscopic cholecystectomy

Objective:To explore the causation,diagnosis and management of iatrogenic bile duct injury(BDI) of laparoscopic cholecystectomy (LC). Methods :A total of 1 656 patients undergoing laparoscopic cholecystectomy in our department during the last 7 years were included in this study for retrospective analysis. Results:There were 274 patients with gallbladder polyps,168 patients with acute calculous cholecystitis and 1214 patients with chronic calculous cholecystitis.There were 15 BDIs associated with LC(0.91%).A total of 8 BDI patients were diagnosed during cholecystectomy. The remaining 7 BDI patients were diagnosed postoperatively.The intraoperative diagnosis of BDI was made on the discovery of bile leakage or double biliary stump during cholecystectomy.Clinical features, diagnostic abdominocentesis and imaging findings formed the basis of diagnosis of BDI postoperatively. One BDI patient was treated by repairing the injuried common bile duct with a T-tube drinage. Four BDI patients were treated by end-to-end anastomosis of injuried bile duct, and one of the four patients was reoperated with Roux-en-Y hepaticojejunostomy because of bile leakage. The remaining 10 BDI patients were treated by Roux-en-Y hepaticojejunostomy, and good results were achieved in all of these patients. Conclusions:There is no relationship between the etiology of gallbladder disease and BDI during laparoscopic cholecystectomy. Good results can be achieved if BDI is diagnosed early and treated properly during or after operation. Roux-en-Y hepaticojejunostomy is the primary operation method for treating BDI.