胆囊切除术中损伤胆管的原因分析和防治体会

目的：研究在胆囊切除术中，损伤肝外胆管的的原因和预防方法；方法：对２０年来胆囊切除术发生肝外胆管损伤的病例行回顾性系统分析；结果：１０５０例胆囊切除术３１例胆管损伤的病例，损伤发生率为２．９５％。３１例中９例为胆管完全横断；损伤超过周径５０％的２例，不足５０％的７例，因钳夹过度撕死伤９例；链扎伤４例。术中发现损伤２２例，当即行胆道重建术，其中端端吻合７例，胆管总十二指肠吻合２例，修补１２例，拆除缝

THE REASONS ANALYZED AND THE EXPERIENCE OF PREVENTION AND MANAGEMENT OF INJURY OF BILE DUCT IN CHOLECYSTECTOMY

Objective:To investigate the reasons and preventive methods in injury of bile duct out of the liver in cholecystectomy.Methods:The cases that injure of bile duct in cholecystectomy during past 20 years were analyzed retrospectively.Results:We reviewed the 31 patients of injures to the lile duct among the 1050 cholecystectomies in the past 20 years .Total incidence for bile tract injury was 2.95%,and complete ,transection occurredon 9.Transection for more than 50% of thd circumference on 2,less than 50% on 7.Injury of press and tearing by pliers on 9,suture injure on 4.Twenty two were found during the cholecystectomy and were treated by bile duct reconstruction immediately.End to end choledochostomy of the bile duct was performed on 7,chledochostomy of duodenum on 2,repairing on 12 and bile duct suture taking out on 1.Nine were found after operation,five received reconstruction with Roux on Y choledochojejunostomy,end to end choledochostomy on 1,bile duct suture taking out on 3.Conclusion:Our conclusion is that dealing with the injures of bile duct during cholecystectomy requires comprehensive understanding of the topoyraphy and variation of the bile duct.