腹腔镜下胆囊三角区结构变异的认识与处理

目的通过在腹腔镜下对胆囊三角区结构变异的再认识,探讨手术处理胆囊三角区结构变异的最佳方式。方法回顾性分析我院2006年12月～2008年12月行腹腔镜胆囊切除（laparoscopic cholecystectomy,LC）术中所见胆囊三角结构区变异158例的临床资料,分别针对胆囊动脉变异、胆囊管汇入胆总管位置变异和胆囊三角区致密粘连结构不清等情况,进行不同的手术操作。结果中转开腹15例,包括Mirizzi综合征Ⅰ型3例,Ⅱ型4例;胆囊管汇入胆总管过低2例;胆囊管开口于胆总管后壁2例;胆囊管与胆总管共同一侧壁并行约2cm1例;冰冻状胆囊三角结构不清2例;胆囊后动脉出血1例。143例完成LC手术,术后并发症5例,其中LC术后胆漏再次手术1例;穿刺孔出血2例,穿刺孔感染1例,胆管残留结石1例（术后2周ERCP后取出结石）。结论熟悉胆囊三角区结构变异的类型,细致解剖胆囊三角区,辨清肝总管、胆总管位置,针对不同的变异采用不同的操作方法,是LC手术成功的关键。

Management and Recognition of Anatomical Variations of the Calot's Triangle during Laparoscopic Cholecystectomy

Objective To summarize the anatomical variations of the Calot＇ s triangle and explore the best method to manage the variations during laparoscopic cholecystectomy （LC）. Methods From December 2006 to December 2008, 158 patients with anatomical variation of the Calot＇ s triangle received LC, the clinical data of the cases were reviewed retrospectively. Results Among the cases, 15 patients were converted to open surgery because of I type Mirizzi syndrome （3 cases）, ]] type Mirizzi syndrome （4 cases）, low location of the convergence of the cystic duct and the common bile duct （2 cases）, cystic duct opening into the posterior wall of the common bile duct （2 cases）, the cystic duct and common bile duct sharing 2-cm lateral wall （1 case）, severe adhesion of the Calot＇ s triangle （2 cases）, and hemorrhage of the posterior cystic artery （1 case）. The LC were completed in 143 patients, among which 5 cases had postoperative complications, including biliary leakage in ! case （cured by a second operation） , bleeding at the puncture sites in 2 patients, infection of the puncture site in 1 case, and residual cystic stones in 1 case （cured by ERCP in 2 weeks）. Conclusions Knowledge of the anatomical variations of the Calot＇ s triangle is the key to LC. Different surgical strategies should be carried out according to the dissection of the Calot＇ s Triangle area, and the location of the common hepatic duct and common bile duct.