腹腔镜胆囊切除术胆管损伤30例防治分析

目的:总结腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)胆管损伤处理经验。方法:回顾性分析30例LC胆管损伤患者的临床资料,并根据胆管损伤的部位、程度及发现的时间采取不同的手术方式。结果:9例于术中及时发现并处理治愈,术后发现21例胆管损伤,病死2例,1例死于胆漏、腹腔感染,另1例死于反复胆管炎、肝功能不全;其余均治愈。结论:LC手术过程应严格遵守操作规程,避免盲目或轻率的钳夹、电切、电凝是预防胆管损伤的关键,发现胆管损伤需行一期或二期手术治疗,降低病死率。

Bile duct injuries in laparoscopic cholecystectomy:analysis of 30 cases

Objective:To summarize the experience in prevention and treatment of bile duct injury during laparoscopic cholecysteclomy (LC).Methods:Retrospective analysis on the clinical data of 30 cases of LC was carried out.The different operation modes were selected according to the injury area and degree of bile duct and the discovered time.Results:Nine cases who treated urgently were recovered well during the operation period.In the 21 cases who were found with bile duct injury after the operation,two cases were died,and in which one was died with leakage of bile and celiac infection,and another was died with reiterative cholangitis and hepatic insufficiency.Other cases were recovered well.Conclusions:During LC,the operative rule should always be strictly complied and the key to preventing bile duct injury is to avoid clipping,cutting and coagulationblindly blindly.