腹腔镜胆囊切除胆管损伤15例临床剖析.docVIP

腹腔镜胆囊切除胆管损伤15例临床剖析 　　中图分类号：R657.4 　　文献标识码： A 　　文章编号： 1672-3783(2008)-7-0001-02 　　 　　【摘 要】目的 探讨腹腔镜胆囊切除术胆管损伤的原因和预防措施。方法 对我院从1998年1月～2005年8月的腹腔镜胆囊切除术中胆管损伤病例进行综合分析。结果 1900例腹腔镜胆囊切除术中胆管损伤15例(0.7％)，其中胆总管横断伤8例，胆总管不完全横断伤2例，肝、胆总管横断伤并组织缺损2例，右副肝管横断伤2例，肝、胆总管机械性裂伤1例。术中发现12例，术后诊断3例。胆管横断伤处理以直接修补、T管引流为主，半年后胆肠Koux―Y吻合，或一期胆总管空肠KoUX―Y吻合术。结论 重视预防和提高手术技能，能降低腹腔镜胆囊切除术中胆管损伤的发生率。 　　【关键词】腹腔镜胆囊切除术 胆管损伤 预防 　　 　　Clinical Analysis of15 CaseswithBile Duct Injuries 　　inLaparoscopic Cholecystectomy 　　TENG Hua-an 　　The Third People’s Hospital of Yibin, Yibin,644000 Sichuan ,China 　　【Abstrac】Objective To investigate the aetiology and prevention of bile duct injuries in laparoseopic Cholecystectomy.Methods A total of 1900 cases underwent laparoscopic cholecystectomy(LC)from Januaryofto August of 2005 were reviewed and analyzed retrospectively．Result Of the 1900 procedures performed，there were 15(0．7％)cases with bile duct injurie. These involved 8 complete transversal injuries of the common bile duct, 2 part transversal injuries of the common bile duect,2 transversal injuries ofHepatic duct transection and the common bile duct, 2 injury of the accessory hepatic duct,1 Mechanical laceration of Hepatic duct transection and the common bile.12 duct injuries were identified during operation and the other 3 cases were diagnosed after opemtion． Thesewere primarily repaired by direct suture or by a Roux-Y biliary-enteric anastomosis．Conclusions The bile duct injuries during laparoseopic cholecystecomy Can be minimized by emphasizing prevention an d improving ope rative techniques． 　　【Key words】Laparoscopic cholecystectomy；Bile duct injury；Prevention 　　 　　腹腔镜胆囊切除术（LC）现已成为胆囊切除的金标准，伴随该手术的不断普及和应用，其相关的手术损伤报导也有增加。在该手术相关并发症中，胆管损伤后果较为常见并且后果严重，其预防和处理有临床价值。本文就我院自1998年1月～2005年8月其15例病例报告如下： 　　 　　1 临床资料 　　 　　1.1 一般情况 我院1998年1月至2000年3月实施LC 280例，发生胆管损伤8例(2.86%)；2000年4月至2003年4月实施LC 410例，发生胆管损伤3例(0．73％)；2003年5月至2005年8月实施LC 1210例，无胆管损伤。15例胆管损伤患者中男6例，女9例；年龄25～75岁，平均52岁；有上腹部手术史4例。10例为慢性胆囊炎胆囊结石，3例为胆囊息肉，2例为急性胆囊炎，