影响腹腔镜胆囊切除术胆道损伤修复效果的因素

目的 探讨影响腹腔镜胆囊切除术胆道损伤修复效果的因素。方法 回顾性分析28例腹腔镜胆囊切除术胆道损伤的发现时间、损伤修复前胆道造影情况、修复方法及其对修复效果的影响。结果 术中发现胆道损伤20例，修复成功19例(成功率为95％)；术后发现胆道损伤8例，修复成功7例(成功率为89％)。28例胆道损伤修复前均行胆道造影评估胆道结构，修复成功26例(成功率为93％)。局部缝合、或伴胆总管切开T管引流修复胆道穿孔、胆道撕裂、胆道部分夹闭或部分切开成功率达100%(21／21)，端端吻合修复术中发现的胆道横断2例均成功，胆肠Roux—en—Y吻合修复胆道横断、缺损、瘢痕狭窄4例，3例吻合成功。结论 早期(术中)发现胆道损伤、修复前对胆道结构进行评估、及对修复术式与方法的正确运用有助于提高胆道损伤的修复效果。

Factors influencing the results of treatment for bile duct injury during laparoscopic cholecystectomy

Objective To discuss factors that influence the results for treatment of bile duct injuries during laparoscopic cholecystectomy. Methods The results of treatment for bile duct injuries in 28 patients during laparoscopic cholecystectomy were reviewed retrospectively, and the effects of injury detection time, cholangiography, repair modality and technique on long term results were analyzed. ResultsRepair of bile duct injuries was successful in 19 (95%) of 20 cases when injuries were recognized intraoperatively, however, the successful rate of repair was 89% (7/8) when injuries were recognized postoperatively. Repairs were successful in 93% (26/28) when complete cholangiography was performed. End to end choledochocholedochostomy was successful in 2 out of 2 transection injury cases. Roux en Y hepaticojejunostomy was successful in 3 of 4 (75%) cases. ConclusionEarly detection of the injuries, complete evaluation of biliary duct, and appropriate surgical modality and technique improve the results of repair for laparoscopic bile duct injuries.