腹腔镜胆囊切除术胆管损伤的诊断及处理

目的总结腹腔镜胆囊切除术（LC）胆管损伤的特点及诊断和处理的经验教训。方法回顾性分析23例LC胆管损伤的诊治情况。结果主胆管损伤12例，其中胆总管横断6例，肝总管横断2例，右肝管横断1例，胆总管横行夹闭1例，胆总管和肝总管裂孔各1例。副肝管损伤11例，其中迷走胆管损伤1例，细小副肝管损伤7例，较粗大的副肝管损伤3例。本组病例全部治愈。结论LC较开腹胆囊切除术更易发生胆管损伤，且损伤更为隐蔽、复杂，处理难，预后差。应根据不同的情况选择适当的手术方式．

The diagnosis and management of bile duct injury during laparoscopic cholecystectomy

Objective To report on the experiences related to diagnosing and managing the bile duct injury in laparoscopic cholecystectomy. Methods To analyse retrospectively the diagnostic and treating experience in 23 cases of bile duct injury. Results Twelve cases of the common bile duct injury, 6 cases of transection of common bile duct, 2 cases of transection injury of common hepatic duct, one case of transec-tion of right hepatic duct, one case of transverse clip block of common bile duct, perforation in each of common bile duct and common hepatic duct. Eleven cases of accessory hepatic duct injury, including one case of aberrant bile duct injury, 7 cases of tiny accessory hepatic duct injury and 3 cases of thick accessory hepatic duct injury. All cases in this group were cured. Conclusion Comparing with LC and open cholecystectomy, occult bile duct injury is more readily to happen in LC with more difficulty in repairment and poor prognosis. Therefore we should strictly select the appropriate operative manual according to patient' s situation.