腹腔镜胆囊切除术112例并3例胆管损伤临床研究.docVIP

腹腔镜胆囊切除术112例并3例胆管损伤临床研究【摘要】目的：探讨腹腔镜胆囊切除术，胆管损伤的预防方法。方法：回顾性分析我院2005年10月至2007年5月，112例LC合并3例胆管损伤的资料。胆管损伤原因：1例为萎缩性胆囊炎，三角区致密粘连，分离时撕裂肝总管行胆管修补，T管引流。1例胆囊管汇入位置胆管横断，行胆管吻合，T管支撑。1例术中胆总管撕裂，行胆管修补，T管引流。结果：胆管修复手术均获成功，随访12~18个月，无胆管狭窄。结论：重视术前对胆囊病变程度的判断及术中采取预防措施，可减少胆管损伤。 【关键词】腹腔镜胆囊切除术；胆管损伤；预防措施 文章编号：1009-5519（2007）22-3331-02 中图分类号：R6 文献标识码：A On conversion to bile duct injury during laparoscopic cholecystectomy： An analysis of 3 cases of bile duct injury out of 112 cases of Laparoscopic cholecystectomy NI Huai-kun （Department of General Surgery，Hospitalof Fuding，Fujian 355200，China) 【Abstract】Objective：To investigate the preventive measures against the injury of bile duct during laparoscopic cholecystectomy (LC). Methods：The investigation was based on 3 patients of bile duct injury out of 112 cases during laparoscopic cholecystectomy (2.7%) from September 2005 to May 2007 in our hospital. The clinical data revealed 3 cases of bile duct injury.One case was atrophic chlecystitis with calot?s triangle clinging closely. The bile duct was injured during anatominzing calot?s triangle，afterwards it was rehabilitated and was dealt with via T-duct drainage. The bile duct was injured in another one during cutting the connection between the common duct and the cystic duct，whereafter the common duct was anastomosed and dealt with via T-duct drainage. The third one was that the common duct was damaged during the surgery operation，and then the bile duct was rehabilitated and was dealt with through T-duct drainage.Results：The conversion to open surgery of rehabilitating common duct was successfully completed in all the 3 cases of patients with bile duct injury. Follow-up examinations for 12～18 months showed no bile duct stenosis. Conclusion：proper preoperative patient seletion and use of intraoperative preventive measures are helpful to minimize the possibility of bile duct injury. 【Key words】Laparoscoic cholecystectomy；Bile duct injury；Preventive measure 随着腹腔镜胆囊切除手术的广泛开展，如何