单中心腹腔镜胆囊切除术预防胆管损伤的体会

目的:探讨如何预防腹腔镜胆囊切除术(LC)胆管损伤。方法:回顾分析37 781例LC的临床资料。结果:胆管损伤25例(0.066%),其中术中发现8例,术后发现17例。胆管横断伤12例,其中离断+缺损8例(1例是中转开腹损伤),钛夹夹闭无胆管缺损4例;胆总管部分剪切伤4例;肝总管电损伤2例,分离损伤2例;右肝管损伤3例;副肝管损伤2例。胆管修补(端端吻合)+T管支撑引流5例、胆肠Roux-en-Y吻合16例,腹腔穿刺+鼻胆管引流1例(ENBD)、损伤胆管修复,置管引流3例。无死亡病例。结论:熟悉肝门解剖,仔细处理Calot三角,适时中转开腹,避免盲目自信可以有效的降低胆管损伤的发生率。

Prevention of bile duct injury in laparoscopic cholecystectomy

Objective:To explore the measures for prevention of bile duct injury in laparoscopic cholecystectomy(LC).Methods:Retrospectively analyze the clinical data of 37 781 cases received LC.Results:Of the 25 cases complicated with biliary duct injury(0.066%),8 were found during the operation,and 17 after the operation.12 cases had transection injury of biliary duct,including 8 cases with mutilation and defect(1 case caused by conversion to laparotomy),and 4 cases due to titanium occlusion with no biliary duct defect.4 cases suffered from partial cutting of common bile duct(CBD);electric injury and seperating injury of common hepatic duct occured in 2 cases respectively;in addition,3 cases had right hepatic duct injury and 2 cases had accessory hepatic duct injury.Among all the cases,5 received bile duct repair(end-to-end anastomosis)and T-tube supporting and drainage;16 underwent chole-enterostomy(Roux-en-Y),1 had abdominal cavity puncture and endoscopic nasobiliary drainage(ENBD),and 3 received bile duct repair and tube drainage.All the cases were cured successfully.Conclusions:Familiar with the anatomy of porta hepatis,careful handling of the Calot~,s triangle,proper conversion to laparotomy,and avoiding of blind confidence could mutually reduce the incidence rate of bile duct injury.