腹腔镜胆囊切除术胆道损伤的因素分析.docVIP

精品论文 参考文献 腹腔镜胆囊切除术胆道损伤的因素分析 （临沂市沂水中心医院 山西 临沂 276400） 【摘 要】目的：探索腹腔镜胆囊切除(1aparoscopiccholecystectomy,LC)致胆管损伤的原因、预防措施和诊治策略。方法：回顾性分析我院2005.1—2015.4共计完成LC 1671例，其中发生胆道损伤的4例,损伤率为0.24%，4例患者中1例患者行胆总管切开T管引流术，1例右侧肝内胆管损伤者行右肝内胆管修补术及引流术。1例迷走胆管未结扎者行迷走胆管结扎腹腔引流术。1例副肝管未结扎者行副肝管结扎+胆道探查术+T管引流术。结果：患者开腹术后平均住院46.5天（14—80天）后病情好转，无腹痛，肝功均恢复正常后出院。随访4—6年，患者均健在，且无胆道症状的发生及肝功异常的发生，生活质量良好。结论：减少LC胆管损伤的关键在于预防。充分了解胆管解剖，精细操作，熟练掌握技巧。胆道损伤应及时发现，正确处理，以获得满意的预后。 【关键词】腹腔镜；胆囊切除术；胆管损伤 【中图分类号】R575.6 【文献标识码】A 【文章编号】1004-6194（2015）02-0296-02 【Abstract】Objective：To explore the cause of bile duct injury caused by laparoscopic cholecystectomy(LC) and their prevention and treatment.Methods: Retrospective analysis of 2005.1-2015.4 with complete LC 1671 cases, including 4 cases of bile duct injury, the injury rate was 0.24%, 1 case of patients with common bile duct in four patients cut T tube drainage, 1 case of right intrahepatic bile duct injury right intrahepatic bile duct repair and drainage. 1 case of vagus bile duct un-neutered line vagus bile duct ligation abdominal cavity drainage. Where no ligation in 1 pair of hepatic duct line pair of hepatic duct ligation + bile duct exploration,T tube drainage.Results: postoperative patients with laparotomy average hospitalization after 46.5 days (14-80 days) got better, no abdominal pain, liver meritorious service is back to normal after hospital discharge. Follow-up of 4 to 6 years, the patients were alive, without the occurrence of biliary symptoms and abnormal liver result, good quality of life.Conclusion：The key to reduce the BDI in LC is to prevent in advance.The operator of LC should be experienced,grasp the anatomy of bile duce and have the idea of transferring to normal operation promprly.The bile duct injury caused by LC should be found and tackled in time in order to achieve satisfactory prognosis. 【Keywords】laparoscope；cholecystectomy；bile duct injury 腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）是胆道外科常用的手术，分为顺行性（由胆囊管开始）切除和逆行性