腹腔镜胆囊切除术中胆管损伤的诊治体会

目的 探讨腹腔镜胆囊切除术中胆管损伤的原因、预防和治疗原则.方法 回顾性分析我院10多年来8000例LC中发生胆管损伤病例的临床资料.结果 全组15例发生胆管损伤,发生率为0.18%,其中肝,总管横断2例,胆总管横断2例,胆管节段性缺损2例,肝外胆管裂伤穿孔3例,胆总管部分钳夹6例.除1例为术后胆漏、胆汁性腹膜炎再次手术时发现,其余均为术中发现.全组均治愈.结论 LC术中胆管损伤,将胆总管误认为胆囊管是最常见的原因,若能术中发现及时处理,预后较好,熟悉肝外胆道系统的生理及病理解剖变异,强化操作训练,正确掌握手术适应症,把握中转开腹的时机可减少胆管损伤的发生,治疗原则是及早发现和及时处理胆道损伤,解除梗阻,重建胆道-空肠通路,防止胆管狭窄.

Clinical Experience of the Treatment for Bile Duct Injuries during Laparoscopic Cholecystectomy

Objective To investigate duct injuries during laparoscopic the causes, prevention and therapeutic principle of bile cholecystectomy. Methods 8000 clinical cases of our hospital in a decade underwent laparoscopic cholecystectomy were analyzed retrospectively. Results 15 cases suffered intraoperative bile duct injuries, the overall rate is 0.18%. Transection of common hepatic duct occurred in 2 cases, transection of common bile duct occurred in 2 cases, segmental injury of extrahepatic biliary tract occurred in 2 cases, perforation of extrahepatic biliary tract occurred in 3 cases, and incomplete clip of common bile duct occurred in 6 cases. All of these cases were cured. Conclusion Several factors have been implicated in biliary injuries intraoperatively. Mistaking the common bile duct for the cystic duct was most common. The earlier the injuries were recognized, the better the prognosis turned out. Besides, familiarity with the anatomy of extrahepatic bile tract and its variations, advanced training of practice, well-controlled operation indications, and appropriate timing of conversion to open operation can decrease the bile duct injury rate. The therapeutic principles include early reorganization and appropriate management of injures as soon as possible, relief of obstruction, biliary-jejunum pass reestablishment, and prevention of the stricture of biliary tract.