摘要
目的分析腹腔镜胆囊切除术(LC)胆管损伤的原因及处理措施。方法对自2004年1月至2011年12月行LC患者3156例进行分析,发生胆道损伤6例,术中发现4例,术后胆漏发现2例。其中,胆囊床胆漏1例,胆总管横断1例,肝总管钛夹不全夹闭1例,右肝管夹闭并前壁剪开1例,副右肝管夹闭横断1例,电钩损伤右肝管前壁1例。胆囊床胆漏及副右肝管夹闭未做处理2例;胆管对端吻合并置T管支撑引流2例;取出生物夹,行T管支撑引流1例;术后胆瘘1例,术后7 d再次开腹发现右肝管前壁坏死脱落,行坏死组织清除,T管支撑引流,大网膜覆盖。结果胆囊床漏胆及副右肝管夹闭未做处理2例术后随访5年,未发现肝脏萎缩及胆道狭窄;4例行T管支撑引流者,术后随访17～60个月,平均34个月,未出现任何不适,无胆管狭窄及其他并发症。结论术者对LC潜在危险性缺乏足够重视,经验不足或者盲目自信,镜下不能正确判断变异解剖关系,器械使用不当,是发生胆管损伤的根本原因。严格掌握手术适应证,强化操作训练,把握中转开腹的时机,可减少胆管损伤的发生。
Objective To investigate the etiology and treatment methods of bile duct injuries in laparoscopic eholecystectomy. Methods From Jan. 2004 to Dec. 2011,the clinic data of patients in laparoscopic cholecystectomy in our department were analyzed. Results Of the 3156 cases performed, there were 6 （0.19%）cases with bile duct injuries; 4 cases were found in operation and 2 cases were diagnosed after operation.Of the 6 cases, 2 cases were no treatment;4 cases were repaired by direct suture and＂T＂type tube to drain and sustain, following 17-60 months No cases have severe complications. Conclusion To avoid bile duct injuries,we have to abide by the procedure.The indication of laparoseopic cholecystectomy （including emergency）should be mastered strictly.The timely identification and treatment of injured bile duct can decrease effectively the chance of reoperation.
出处
《中华腔镜外科杂志（电子版）》
2013年第6期44-46,共3页
Chinese Journal of Laparoscopic Surgery(Electronic Edition)
