腹腔镜胆囊切除致高位胆管损伤的处理

目的 左、右肝管及其汇合部损伤是腹腔镜胆囊切除术(LC)胆管损伤的最严重类型，处理十分棘手，通过对16例胆管损伤的分析，总结经验教训。方法 回顾性分析LC致16例左、右肝管及其汇合部损伤的原因及处理方法。结果 LC术中发现胆管损伤11例，行肝门部胆肠Roux-ey-Y吻合5例，无症状随访1～58个月；行胆管断端对端吻合5例，均再次行胆肠Roux-en-Y吻合，4例无症状，随访16-56个月，1例手术失败，先后5次手术。1例左、右肝管外引流，等待再次手术。LC术后发现胆管损伤5例，行胆肠Roux-en-Y吻合1例(术后第1天)；行左、右肝管引流2例，术后3月行胆肠Roux-en-Y吻合，无症状随访12-18月；2例行右肝管外引流，等待再次手术。结论术者的过于自信，求速度，操作不当是造成此类胆管损伤的主要原因，左、右肝管成形，胆肠Roux-en-Y吻合是此类胆管损伤修复的最佳方式。

TREATMENT OF HIGH BILE DUCT INJURY CAUSED BY LAPROSCOPIC CHOLECYSTECTOMY

Objective High bile duct injury is a severe complication in LC,and its treatment is difficult.In this study,data from 16 patients with high bile duct injury were analyzed .Methods The cause and treatment approach of the 16 cases were retrospectively analyzed.Results The injury was found in 11 cases during the operation.Roux en Y choledchojejunostomy were performed in 5 cases who were followed up for 1 to 58 month.5 patients underwent end to end bile duct anastomosis and 4 of them were followed up for 16 to 56 month without any symptom.One patient underwent 5 times of operation because of the failure of primary reparation.The bile duct drainage were performed in 1 case.5 case injury were found after LC.The choledchojejunostomy were manipulated in 1 case one day after the operation.Bile duct drainage were performed in 2 patients and Roux en Y choledchojejunostomy were carried out 3 month after the operation.They were followed up for 12 to 18 month.Another 2 patients underwent right hepatic duct drainage to wait for the next operation.Conclusions The main cause of bile duct injury is improper manipulation and self conceit.The left and right hepatic duct plastic and Roux en Y choledchojejunostomy is the optimal performance.The operation should be carried out by experienced surgeon.