摘要
目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中胆囊管解剖变异的诊断及处理。方法:回顾分析1999年1月—2013年12月在复旦大学附属中山医院青浦分院行LC的4652例患者的临床资料,其中胆囊管发生解剖变异者34例,包括胆囊管异常粗、短11例,高位汇入右肝管7例,低位汇入肝总管下端6例,从肝总管前方绕至左侧汇入肝总管1例,与肝总管并行一段后汇入胆总管3例,Mrizzi综合征4例,内脏反位2例。结果:34例胆囊管有解剖变异的患者中,22例成功行LC,12例中转开腹行胆囊切除术。9例出现并发症,均为胆管损伤,经处理后恢复良好,无远期并发症发生。结论:LC术前难以诊断胆囊管解剖变异,LC术中重视胆囊管解剖变异、细致地解剖胆囊三角、辨认各管道关系,是预防并减少胆管损伤的关键。
Abstract Objective：To explore the diagnosis and management of anatomic variation of the cystic duct during laparoscopic cholecystectomy（LC）. Methods：From Jan 1999 to Dec 2013,4652 cases of LC, which were performed in Qingpu Branch of Zhongshan Hospital,Fudan University, were retrospectively analyzed. A total of 34 cases of anatomic variation of the cystic duct were found. Among the 34 cases of anatomic variation of the cystic duct,11 cases had thick and short cystic duct,7 cases had a cystic duct converged into right hepatic duct,6 cases had cystic duct converged into lower part of common hepatic duct, 1 case had cystic duct pronated forward and converged into common hepatic duct from left side, 3 cases had cystic duct that paral- lel itself with common hepatic duct and then converged into common bile duct, 4 cases were diagnosed with Mrizzi syndrome, 2 cases had situs viscera inversus. Results： Among the 34 cases with anatomic variations of cystic duct, 22 cases successfully un derwent LC, the other 12 cases were converted to open cholecystectomy. All the complications were biliary duct injury that re covered well after treatment. Conclusions： Anatomic variation of the cystic duct is hard to diagnose preoperatively. Paying More attention to the anatomic variation during LC, dissecting calot＇s triangle carefully, and identifying the relationship between the various pipeline is the key to prevent and reduce the hiliary duct injury.
出处
《中国临床医学》
2014年第3期332-333,共2页
Chinese Journal of Clinical Medicine
关键词
腹腔镜
胆囊切除术
胆囊管
解剖变异
诊断
处理
Laparoscopy
Cholecystectomy
Cystic duct
Anatomic variation
Diagnosis
Management
