LC致胆道损伤的外科治疗

目的 分析腹腔镜胆囊切除术发生胆道损伤的原因，探讨预防胆道损伤及损伤后修复的方法。方法 对13例LC并发胆道损伤患者进行回顾性分析。结果 病理因素及局部解剖学变异是LC致胆道损伤的主要原因，操作细节欠缺、过分追求低中转开腹率是LC致胆道损伤的常见诱因。12例患者分别采用胆总管对端吻合、Roux—en—Y胆肠内引流、修补后T型管引流等方式进行修复均获得了较好预后。结论 为避免胆道损伤，LC术中应注意操作细节，仔细辨别胆囊管周围解剖关系，疑难病例应适时、果断中转开腹。胆道裂伤或小缺损可行单纯缝合加T型管引流；Roux—en—Y胆管空肠吻合为LC致胆道横断伤或胆道狭窄的理想修复方法；即时手术、条件允许情况下，胆管横断伤也可采取胆管对端吻合的修复方式。

PREVENTION AND TREATMENT OF IATROGENIC EXTRA-HEPATIC BILE DUCT INJURY DURING LC PROCEDURE

Objective To analyze the causes and to discuss the prevention and treatment of iatrogenic bile duct injury during LC procedure.Methods Retrospective analysis on 13 patients with iatrogenic injury on extraheptic bile duct during LC procedure was performed.Results Pathological reasons and anatomy variation were the main causes which led to the iatrogenic bile duct injury during LC procedure. The expansion of LC indication and operators' experience also played very important roles in the occurrence of bile duct injury coupled with LC. Good prognosis were achieved in 12 out of all patients in this group, no mater they underwent choledochectomy,Roux en Y choledochojejunostomy, or choledwchorrhaphy with drainage.Conclusion Carefully anatomizing and distinguishing cystic duct and the suitable time of interruption of LC could prevent bile duct from injury effectively. Choledochectomy and Roux en Y choledochojejunostomy might be the ideal renovation methods in the treatment of bile duct injury during LC procedure. Choledochorrhaphy with drainage may also lead to a good result on the patients with laceration of light defect on bile duct.