肝外型右肝管变异与医源性胆管损伤

目的: 探讨合并有肝外型右肝管变异者行胆囊切除时易致医源性胆管损伤的危险因素及防治方法。方法: 回顾性分析15年来收治的25例合并有肝外型右肝管变异、行胆囊切除时所致的医源性胆管损伤者的临床资料。结果: 损伤原因主要是将右肝后叶胆管误认为是胆囊管而一并切除，损伤部位以II类多见。结论:提高对肝外型右肝管变异的胆管异常解剖结构的认识及胆囊切除时遵循“辨－切－辨”三字原则，是预防医源性胆管损伤的关键。损伤后的诊断时间与损伤类型及手术方式的正确选择是提高治疗效果的重要因素。

Extrahepatic aberrance of right hepatic duct and iatrogenicbile duct injury

Abstract:Objective:To investigate the risk factors and methods for prevention and treatment of iatrogenic bile duct injury caused by cholecystectomy in patients with extrahepatic aberrance of right hepatic duct.Methods :The clinical data of 25 patients with extrahepatic aberrance of right hepatic duct and iatrogenic bile duct injury during cholecystectomy treated in our hospital from Match, 1990 to June, 2005 were retrospectively analyzed.Results:The bile duct of right posterior lobe was erroneously regarded as the cystic duct and resection was the major reason for its injury. The major injury type was class Ⅱ. Conclusions:A heightened awareness of abnormal bile duct anatomy such as extrahepatic aberrance of right hepatic duct and following the principle of “identification-cut-identification” during cholecystectomy is important for prevention of iatrogenic bile duct injury. Important factors in improving the therapeutic outcome of bile duct injury are the time when diagnosis of the injury was made,the type of the injury and the correct selection of surgical procedure.