腹腔镜胆囊切除术中胆管损伤的原因、类型和处理

目的探讨腹腔镜胆囊切除术(LC)中胆管损伤的原因、类型及处理措施。方法回顾分析本科1993年3月-2004年7月腹腔镜胆囊切除术的临床资料。结果LC9200例中,胆管损伤11例,发生率0．12％。其中急诊LC475例,急诊率5．16％,无一胆管损伤;中转开腹193例,中转率为2．09％,中转开腹胆管损伤2例,损伤率1．05％。胆管损伤术中发现8例、术后诊断3例;胆管修补(端端吻合) T管支撑引流6例、胆肠Roux-en-y吻合4例,腹腔穿刺 鼻胆管引流1例(ENBD);再次胆道手术1例,再手术率9．09％。结论遵循辨-切-辨手术程序是避免LC胆管损伤的关键;严格掌握LC和急诊LC的适应证,果断及时中转开腹是避免胆管损伤的重要手段;及时发现实时处理胆管损伤能有效降低胆管损伤的再手术率。

Causes, types and treatment methods of bile duct injuries in laparoscopic cholecystectomy

To investigate the aetiology, types and treatment methods of bile duct injuries in laparoscopic cholecystectomy. From March 1993 to July 2004, the clinic data of patients in laparoscopic choleyatectomy in our department were analyzed. Of the 9 200 cases performed, there were 11(0.12%) cases with bile duct injuries; 475 cases were emergency, but no bile duct injuries; there were 193 (2.09%) cases were abdominocholecystectomy; 2(1.05%) cases were diagnosed after operation. Of the 11 cases, the bile duct of aix cases were repaired by direct suture and "T" type rubber tube to drain and sustain; four cases were remedied by Roux-Y biliary-enteric anastomosis; one cases was treated by abdominocentesis and drainge of endoscopic naso-biliary drainge (ENAD). Among the 11 cases, only one case (9.09%) was operated again. Conclusions] To avoid bile duct injuries, we have to abide by the procedure, that is, recognize-cut-recognize again. The indication of laparoscopic choleccystectomy (including emergency) should be mastered strictly. Changing laparoscopic cholecystectomy to abdominocholecystectomy is an important method to avoid bile duct injury. The timely idertification and treatment of injured bile duct can decrease effectively the chance of reoperation.