腹腔镜胆囊切除术中胆管损伤防治分析

目的探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）术中胆管损伤原因,总结处理经验。方法回顾性分析1998年10月-2006年8月1 528例LC术中9例（0.59%）胆管损伤的资料。结果本组7例术中发现胆管损伤,4例予局部压迫处理,1例术中置入T管引流,2例中转开腹手术。另有2例术后出现胆汁性腹膜炎而二次手术,术中发现胆总管损伤,予T管支撑引流治愈。开展LC的前500例中发生胆管损伤6例（1.20%）,其中中转开腹手术2例（0.40%）;500例以后的LC,胆管损伤率为0.29%（3/1 028）,中转开腹率为0。结论LC术中胆管损伤多发生在复杂病理改变的病例,强化对解剖变异、高危病例及高危技术的认识是避免胆管损伤的关键;一旦发生LC术中不能良好处理的胆管损伤,及时中转开腹手术是理性的选择。

Prevention and Treatment for Bile Ducts Injury in Laparoscopic Cholecystectomy

Objective To assess the causes of the bile ducts injury in laparoscopic cholecystectomy （LC） and conclude the therapeutic experiences, Methods From October 1998 to August 2006, 9 patients （0.59%） suffered bile duct injury in 1 528 patients underwent LC. The clinical data was analyzed retrospectively, Results In the 7 cases who were found bile duct injury intro-operatively, 4 were cured by local compression, 1 was cured by biliary drainage by T-shaped tube, and 2 conversed to open surgery. The bile duct injury rate of the first 500 cases was 1.2% （6/500）, among which 2 cases（0.40% ） conversed to open surgery. And the bile duct injury rate after the first 500 cases was 0.29% （3/1 028 ）, and no one conversed to open. Conclusions Bile ducts injury in LC are associated with complicated pathological changes. It is the key points to learn the knowledge of anatomy variation, the high risk cases and the high risk techniques. Once the bile ducts injury could not be treated well by LC, it is an effective selection to use open cholecystectomy.