腹腔镜胆囊切除术中特殊类型胆囊管的处理

目的介绍腹腔镜胆囊切除(LC)术中对某些特殊类型胆囊管的处理方法。方法本组12000例LC中约5％的胆囊管具有特殊解剖或病变解剖形状，对其腹腔镜下的处理技术及结果进行了回顾性分析。结果2例因直径过细而漏夹闭或直径过粗而夹闭不全的胆囊管术后出现胆汁漏，1例因胆囊管电热损伤，于术后第9天发生胆汁性腹膜炎。其余病人均获得一期恢复。结论LC术中宜根据这类特殊胆囊管的具体病变和解剖，针对性地采用不同的处理措施来避免常规方法可能带来的诸如胆囊管残端漏、肝外胆管损伤、胆囊管残留结石等并发症。

Management of uncommonly shaped cystic duct during laparoscopic cholecystectomy

Objective To introduce the techniques for management of the cystic duct (CD) with uncommonly shaped anatomy or lesion during laparoscopic cholecystectomy (LC). Methods For the 12 000 cases of LC in this group, the CD with uncommon anatomic shape nearly accounted for 5%. The techniques and results of management for these types of CD were retrospectively analyzed. Results Bile leakage developed in 3 patients. Of these 3 patients, the first was with extremely slend CD, the second with a large CD and the third with CD caused by thermal injury. Conservative management succeeded in the former 2 patients and laparotomy was required in the third. Other patients recovered uneventfully. Conclusions Varied techniques should be applied to deal with these commonly shaped CD according to their anatomic structure to avoid complications such as bile leakage and bile duct injury, etc. that may be associated with routine management.