腹腔镜胆囊切除术中胆管损伤常见原因及对策探讨.docVIP

腹腔镜胆囊切除术中胆管损伤常见原因及对策探讨 　　【摘要】 目的：对腹腔镜胆囊切除手术中胆管损伤的主要原因进行分析，同时提出相应的解决策略。方法：选取2002年4月-2016年4月于本院进行腹腔镜胆囊切除术治疗并发胆管损伤的20例患者作为研究对象，按照Strasberg分型和临床资料进行分类，将5例患者于手术中发现胆道损伤并及时进行处理作为研究组，15例患者择期进行处理作为常规组，比较两组患者临床治疗效果。结果：研究组无患者发生胆管炎，常规组胆管炎发生率为53.33%，研究组明显低于常规组，比较差异有统计学意义（P0.05）。结论：局部粘连与胆管变异是导致胆管发生损伤的关键性原因，因此需要按照术中的及时诊断和损伤类型进行处理，保证手术治疗效果，修复胆管损伤情况。 　　【关键词】 腹腔镜； 胆囊切除术； 胆管损伤； 对策 　　Common Causes and Countermeasures of Bile Duct Injury during Laparoscopic Cholecystectomy/GUAN Yang-shi，CHEN Xu-hui.//Medical Innovation of China，2016，13（22）：101-103 　　【Abstract】 Objective：To analyze the main causes of bile duct injury during laparoscopic cholecystectomy and propose the corresponding solutions.Method：From April 2002 to April 2016，20 cases of bile duct injury treated by laparoscopic cholecystectomy in our hospital were selected as the research subjects，they were classified according to Strasberg classification and clinical data，the bile duct injury was found in 5 cases and was treated in time as the research group，15 cases selective treatment were treated as the routine group，the clinical therapeutic effect of the two groups were compared.Result：The research group had no angiocholitis occurrence，the routine group cholangitis incidence rate was 53.33%，the research group was significantly lower than routine group，the difference was statistically significant（P0.05）.Conclusion：Local adhesion and bile duct variation are the key causes of bile duct injury，therefore，prompt diagnosis and type of injury should be timely processed in accordance with the procedure to ensure the effect of surgical treatment and repair of bile duct injury. 　　【Key words】 Laparoscopy； Cholecystectomy； Bile duct injury； Countermeasures 　　First-author’s address：The Affiliated Luohu Hospital of Shenzhen University，Shenzhen 518000，China 　　doi：10.3969/j.issn.1674-4985.2016.22.028 　　腹腔镜胆囊切除术（LC）近年来逐渐变成临床上治疗胆结石的一种关键性方式，已变成良性胆囊疾病的治疗主要标准。然而不少研究证明，LC胆管损伤的发生几率为0.4%～0.7%，其中开腹胆囊的切除手术胆管损伤的发生率高[1]。我国相关文献[2]中指出，国内LC胆管的损伤发生率约大