摘要
目的探讨腹腔镜胆囊切除术(LC)胆道损伤的原因及其预防。方法回顾性分析2011年3月至2018年9月在安徽省淮南市新华医院接受LC的1157例患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男519例,女638例;平均年龄(48±6)岁。急性胆囊炎214例,慢性胆囊炎943例。以患者术中、术后胆道损伤和胆漏等作为主要观察指标,分析患者胆道损伤发生情况及其危险因素。胆道损伤发生率比较采用χ2检验。结果胆道损伤发生率为0.43%(5/1157),其中迷走胆管损伤致胆漏2例,过度剥离胆囊床导致右肝管损伤1例,胆囊管开口变异致右肝管损伤1例,胆囊管过度牵拉致胆总管损伤1例。择期手术患者LC胆道损伤发生率为0.4%(4/943),急诊手术为0.5%(1/214),差异无统计学意义(χ2=0.231,P>0.05)。主治医师行LC的胆道损伤发生率为1.1%(4/370),明显高于副主任及以上医师的0.1%(1/787)(χ……2=5.324,P<0.05)。LC经验<20例的主刀医师行LC的胆道损伤发生率为1.3%(3/229),20~100例的0.2%(1/525),>100例的0.2%(1/403),差异有统计学意义(χ……2=3.787,P<0.05)。结论胆道解剖变异、组织粘连等是胆道损伤常见的影响因素。有丰富经验的医师主刀、术前熟练掌握胆道解剖变异、术中重视胆囊三角区的钝性分离和精细操作是预防并降低LC术中胆管损伤的关键。
Objective To investigate the causes and prevention of bile duct injury in laparoscopic cholecystectomy(LC).Methods Clinical data of 1157 patients undergoing LC in Huainan Xinhua Hospital in Anhui province from March 2011 to September 2018 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,519 patients were male and 638 female,aged(48±6)years old on average.A total of 214 cases were diagnosed with acute cholecystitis and 943 cases of chronic cholecystitis.The incidence of intraoperative and postoperative bile duct injury and bile leakage were taken as the primary observation parameters.The incidence of bile duct injury and its risk factors were analyzed.The incidence of bile duct injury was statistically compared by Chi-square test.Results The incidence of bile duct injury was 0.43%(5/1157),including 2 cases of bile leakage caused by vagus bile duct injury,1 case of right hepatic duct injury induced by excessive resection of gallbladder bed,1 case of right hepatic duct injury caused by variation of cystic duct opening and 1 case of common bile duct injury caused by excessive stretching of cystic duct.The incidence of bile duct injury in patients undergoing elective LC was 0.4%(4/943)and 0.5%(1/214)for those undergoing emergency LC where no significant difference was observed(χ^2=0.231,P>0.05).The incidence of bile duct injury in LC performed by the attending physicians was 1.1%(4/370),significantly higher than 0.1%(1/787)in LC performed by the deputy chief and above physicians(χ^2=5.324,P<0.05).The incidence of LC bile duct injury in the surgeons with LC experience<20 cases was 1.3%(3/229),and was 0.2%(1/525)for those with LC experience of 20-100 cases and 0.2%(1/403)for those>100 cases,where significant differences were observed(χ^2=3.787,P<0.05).Conclusions Anatomical variation and tissue adhesion of bile duct are the common impact factors of bile duct injury.Experienced surgeons,good command of anatomical variati
作者
伍万权
Wu Wanquan(Department of General Surgery,Huainan Xinhua Hospital,Huainan 232000,China)
出处
《中华肝脏外科手术学电子杂志》
CAS
2019年第6期538-541,共4页
Chinese Journal of Hepatic Surgery(Electronic Edition)
关键词
胆囊切除术
腹腔镜
胆道损伤
危险因素
预防
Cholecystectomy,laparoscopic
Bile duct injury
Risk factors
Prevention
