腹腔镜胆囊切除术致胆管损伤的原因及预防.pdfVIP

维普资讯 2008年2月第 46卷第6期 · 临床研究 · 腹腔镜胆囊切除术致胆管损伤的原因及预防 工 春 成南峰 梁万锋 (重庆永川Ⅸ中医院，重庆 402160) [摘要】目的 探讨腹腔镜胆囊切除手术后致胆管损伤的原因及预防措施。方法 回顾性分析胆囊切除术致胆管损伤的8例 临床资料。结果 1例胆总管横断，1例盲 目止血部分夹伤胆总管，3例胆总管前侧壁撕裂伤，2例胆总管部分电灼伤 ，1例胆 总管大部被夹闭。本组患者在经适当处理后恢复 良好。结论 胆管损伤在术中早期发现并且妥善处理是防止术后胆管漏的 主要预防措施。 [关键词】腹腔镜；胆囊切除术；胆肠吻合术；胆管损伤 [中图分类号】R657．4 [文献标识码】A 文【章编号】1673—9701(2008)06-37-02 AnalysisofCausesandPrevention oftheBlieDuctInjuryin Laparo- scopic Cholecystectomy WANG Chtm CHENG Nanfeng LIANG Wanfeng TraditionalChineseMedicalHospitalofYongehuanRe,oninChongqing，Chongqing402160 A【bstract】Objective To explore the causesofbile ductinjury oflaparoscopic cholecystectomy，and its prevention methods． MethodsTheclinical dataof8casesofbileductinjury oflaparoscopiccholecystectomywasanalyzedretrospectively．Results 1 case had choledoch transection；W ith blind hemostasia hte choledoch had been damaged partly in 1 case；Laceration ofvenwiolateral wallofthe extrahepatic bile ductwas 3 c3~ses，and the common hepatic ductelectro-burn were 2 cases．The choledoch close by titanium clip was1case．Allofthese caseswere cured after theappropriate rteatment．Conclusion Thebileductinjury of laparoscopic cholecystectomy should be discovered as early as possible and being taken appropriate measures，which could avoid the occurrenceofbileductleakage afterthe operation． K【eyWords】Laparoscope；Ch0lecystect0my；Cholangioenterostomy；Bileductinjury 在腹腔镜胆囊切除术 (LC)中，胆道损伤是最常见、最严重的 壁修复T管支撑引流，术后 6个月拔管，恢复良好，1例造成胆管 并发症之一。但南于各种原因的影响，术中致胆管损伤屡有报 壁缺损修补困难而行胆管空肠 Roux—en—Y吻合术，术后 l2个月 道。现将我院2000年以来，腹腔镜胆囊切除术后发生胆管损伤 拔管，恢复良好 ，随访2年，无不适症状；1例盲 目止血后部分夹 的病例进行分析，现报道如下。 伤胆总管，中转开腹，行胆管十二指肠吻合术 ，左右