腹腔镜胆囊切除术中胆管损伤的预防和处理

目的 探讨腹腔镜胆囊切除术(LC)中胆管损伤的原因和处理办法。方法 2002年12月至2004年3月739例胆囊疾病患者，均行腹腔镜胆囊切除术，对其临床效果进行回顾分析。结果 发生胆管损伤5例(0．68％)，其中胆管穿洞性损伤1例，副肝管损伤1例，电灼伤致胆管缺损1例，胆管横断伤2例。1例穿洞伤行开腹侧壁修补，T管支撑引流，恢复良好；1例副肝管损伤行开腹副肝管结扎，T管引流治愈；胆管缺损1例及胆管横断2例行肝门空肠围套式吻合，2例效果良好，1例发生胆管狭窄，予再次手术。无死亡病例。结论 腹腔镜胆囊切除术中，应熟悉局部解剖，熟练掌握正规手术操作技术。发生胆管损伤，根据损伤情况和术后时间选择不同的处理方法。

Prevention and treatment of bile duct injury during laparoscopic cholecystectomy

Objective To study the causes and treatment of the bile duct injury during laparoscopic cholecysectomy. Methods The laparoscopic cholecysectomy was performed in 739 cases during December 2002 to March 2004.The therapeutic effect was analysized retrospectively. Results The injuries were in bile duct(n=5),bile duct perforation(n=1),accessory hepatic duct (n=1),by electric burn caused,bile duct defect(n=1) and bile duct transection damage (n=1). One perforation wound were performed laparotomy for lateral wall repairiong with T tube drainage,one accessory hepatic duct injuring were treated by hepatic duct ligation T tube. Hepatic portal- jejunum anistomosis was performed in 1 case of burned bile duct defect and 2 cases of bile duct transection. Conclusion In laparoscopic cholecystomy the intimate knowledge of regional anatomy is required.The standard surgical technique may prevent the bile duct injury as possible,if it occurs during operation the different treatment approaches should be selected according to various injuries.