腹腔镜胆囊切除术胆管损伤的防治体会

目的：探讨腹腔镜胆囊切除术中胆管损伤的原因及防治方法。方法：回顾性分析2004～2006年的527例腹腔镜胆囊切除术,其中胆管损伤6例,包括胆总管横断2例,胆总管夹闭1例,胆囊管残端漏1例,胆囊迷走胆管损伤2例。胆总管损伤患者均行一期手术,胆囊迷走胆管损伤患者置管引流治愈。结果：本组患者1例因发生胆管狭窄后再次手术行Roun-en-y吻合术,其它患者恢复顺利。结论：严格规范的操作,胆囊三角良好的显露,辨清肝总管、胆总管和胆囊管之间的关系,必要时中转开腹,是避免肝外胆管损伤和预防胆漏的关键。

Prevention and treatment of bile duct injury in laparoscopic cholecystectomy

Objective:To study the causes of bile duct injury in laparoscopic cholecystectomy(LC) and its methods of prevention and treatment.Methods:The clinical data in 527 patients undergoing the laparoscopic cholecystectomy in our hospital from 2004 to 2006 were analysed retrospectively,in which 6 cases suffered from bile duct injury,including transverse injury of the hepatocystic duct 2 cases,transverse clip shut of hepatocystic duct 1 case,leakage of cystic duct 1 case,injury of the aberrant bile duct 2 cases.The primary operation and other treatment were performed according to their wound condition.Results:Only one patient was performed with Roun-en-Y cholangio-jejunostomy for bile duct stricture,the others recovered smoothly.Conclusion:Operating strictly and canonically,exposing the triangle of gallbladder favourably,discerning the relationship between common hepatic duct,hepatocystic duct and cystic duct carefully and converting to laparotomy indispensably are the key points for preventing the bile duct injury in laparoscopic cholecy stectomy.