单中心腹腔镜胆囊切除术预防胆管损伤体会.docVIP

单中心腹腔镜胆囊切除术预防胆管损伤体会 　 作者：姜世涛，孙登群，王敬民，龚仁华，尹艳 　【摘要】 目的：探讨如何预防腹腔镜胆囊切除术（ＬＣ）胆管损伤。方法：回顾分析37 781例LC的临床资料。结果：胆管损伤25例(0.066%),其中术中发现8例,术后发现１7例。胆管横断伤12例,其中离断+缺损8例(1例是中转开腹损伤),钛夹夹闭无胆管缺损4例；胆总管部分剪切伤4例；肝总管电损伤2例,分离损伤2例；右肝管损伤3例;副肝管损伤2例。胆管修补(端端吻合)+T管支撑引流5例、胆肠RouxenY吻合16例,腹腔穿刺+鼻胆管引流1例(ENBD)、损伤胆管修复,置管引流3例。无死亡病例。结论：熟悉肝门解剖,仔细处理Calot三角,适时中转开腹,避免盲目自信可以有效的降低胆管损伤的发生率。 【关键词】 胆囊切除术，腹腔镜；胆管损伤 【Abstract】 Ｏbjective:To explore the measures for prevention of bile duct injury in laparoscopic cholecystectomy(LC).Methods:Retrospectively analyze the clinical data of 37 781 cases received LC.Results:Of the 25 cases complicated with biliary duct injury(0.066%),8 were found during the operation,and 17 after the operation.12 cases had transection injury of biliary duct,including 8 cases with mutilation and defect (1 case caused by conversion to laparotomy),and 4 cases due to titanium occlusion with no biliary duct defect.4 cases suffered from partial cutting of common bile duct(CBD);electric injury and seperating injury of common hepatic duct occured in 2 cases respectively;in addition,3 cases had right hepatic duct injury and 2 cases had accessory hepatic duct injury.Among all the cases,5 received bile duct repair (endtoend anastomosis)and Ttube supporting and drainage;16 underwent choleenterostomy(RouxenY),1 had abdominal cavity puncture and endoscopic nasobiliary drainage(ENBD),and 3 received bile duct repair and tube drainage.All the cases were cured successfully.Conclusions:Familiar with the anatomy of porta hepatis,careful handling of the Calot,s triangle,proper conversion to laparotomy,and avoiding of blind confidence could mutually reduce the incidence rate of bile duct injury. 【Key words】 Cholecystectomy,laparoscopic;Bile duct injury 腹腔镜胆囊切除术(LC）目前已成为胆囊切除术的常规手术,但胆管损伤作为LC最严重的并发症,常导致再次甚至多次手术,给患者带来极大的痛苦,如何避免该并发症的发生,国内外许多作者［１，２］进行了多方面的探讨,本文总结了我院胆管损伤的病例经验,现报道如下。 1 资料与方法 11 临床资料 本组包括我院自1992年10月～2005年12月37 781例LC中发生的25例胆管损伤。25例胆管损伤中男16例,女9例；23～65岁,平均43.5岁。其中慢性结石性胆囊炎13例；慢性结石性胆囊炎急性发作4例,其中颈部结石嵌顿3例；萎缩性胆