腹腔镜胆道手术中Luschka管损伤致胆漏的防治

目的:探讨腹腔镜胆道手术中Luschka管损伤的诊断、治疗及预防方法。方法:回顾分析3例腹腔镜胆道手术中Luschka管损伤病例的临床资料。结果:3例患者术前影像学检查均未发现胆道变异情况,均于腹腔镜胆道手术中出现Luschka管损伤,其中2例患者用电钩电切剥离胆囊床,术中发现胆漏,进一步检查发现Luschka管损伤,用可吸收线缝合Luschka管,术后未发生胆漏;1例患者术中用超声刀剥离胆囊床,未发现明显胆漏,术后2 d出现腹痛、黄疸,诊断性腹腔穿刺抽出胆汁,经十二指肠镜逆行胰胆管造影检查证实Luschka管损伤,经腹腔穿刺置管引流+鼻胆管引流术治疗后治愈出院。术后随诊6个月,均未发现胆道狭窄、胆漏、腹腔脓肿等并发症。结论:腹腔镜胆道手术中Luschka胆管损伤难以避免,熟悉解剖、术中提高警惕是防范腹腔镜胆道手术中Luschka胆管损伤的关键。

Prevention and treatment of biliary leakage caused by Luschka bile duct injury in laparoscopic biliary tract surgery

Objective:To investigate the diagnosis ,treatment and prevention of Luschka bile duct injury in laparoscopic biliary tract surgery .Methods:The clinical data of 3 patients with Luschka bile duct injury in laparoscopic biliary tract surgery were retrospec -tively analyzed.Results:No bile duct variation was found in the 3 patients with Luschka biliary duct injury in preoperative imaging ex-amination,all Luschka biliary duct injuries were found in laparoscopic surgery .Two cases of bile leakage were found while peeling the gallbladder bed with electrocautery ,further examination revealed the Luschka duct injury ,Luschka duct was sutured with absorbable su-ture and no bile leakage occurred after operation .The gallbladder bed of 1 patient was peeled with ultrasonic scalpel and no obvious bile leakage was found during the surgery , while abdominal pain and jaundice occurred two days later , diagnostic peritoneal puncture re-vealed the bile ,the ERCP examination confirmed the Luschka duct injury .The patient was cured with the abdominal puncture drainage and endoscopic nasobiliary drainage treatments .No biliary strictures ,bile leakage ,abdominal abscess or other complications were found during the follow-up of six months .Conclusions:It is very difficult to avoid Luschka bile duct injury in laparoscopic biliary tract surger -y,the pivotal issues are being expert in anatomy and keeping constant vigilance in operations .