腹腔镜胆囊切除术后胆道并发症的预防及治疗(附9例报告)

目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)胆道并发症的预防及治疗。方法:回顾分析1995年6月至2010年4月施行6 000例LC术后7例及外院转诊2例胆道损伤的原因及处理措施。结果:9例患者中2例胆漏,经保守治疗痊愈(B超下穿刺引流,内镜鼻胆管引流);1例肝总管横断伤因术后发现较晚、水肿严重,暂行高位胆管引流术;2例术中发现肝总管横断,中转开腹行肝总管空肠Roux-en-Y吻合术,痊愈出院,随访2年,无胆管狭窄;3例术后胆漏,开腹手术,2例胆囊管残端漏行胆囊管结扎术,1例右副肝管胆漏行右副肝管缝合"T"管引流术;1例胆囊管钛夹将胆总管成角钳夹,开腹取夹治愈。全组无死亡病例。结论:解剖变异、病变程度、技术因素是LC导致胆道损伤的常见原因。胆道损伤应及时发现,准确诊断,根据分型正确处理,才能获得满意的预后。

Prevention and treatment of bile duct complications after laparoscopic cholecystectomy:with a report of 9 cases

Objective:To investigate the prevention and treatment of bile duct injury in laparoscopic cholecystectomy(LC).Methods:The cause and management of 7 cases and 2 referral cases bile duct injury after 6 000 cases LC from Jun.1995 to Apr.2010 were analyzed retrospectively.Results:Two cases of bile leakage were cured and discharged by expectant treatment(abdominal puncture and drainage under B-ultrasound combined with endoscopic nasobiliary drainage);One case of common hepatic duct transection was treated by common heptic duct drainage temporarily because of discovering late and severe edema;Two cases of common hepatic duct transection were discovered during the operation,conversion to laparotomy and Roux-en-Y was performed timely,in the following-up of two years after discharge,no bile duct stricture happened;Three cases needed second laparotomy because of bile leakage after operation,two cases of cystic duct stump leakage were performed by cystic duct ligation,one case of vice-right hepatic duct leakage was performed by suture and T-tube drainage;One case of common bile duct occlusion by Ti-clip was cured after taking out of the Ti-clip.None of the patients in this study died.Conclusions:Anatomy anomalies,level of pathological changes and skills are the main factors responsible for bile duct injury.With timely discovery,exact diagnosis,and precise typing,the satisfactory prognosis can be achieved.