腹腔镜胆囊切除术中胆管损伤3例分析.docVIP

腹腔镜胆囊切除术中胆管损伤3例分析 目录 TOC \o 1-9 \h \z \u 目录 1 正文 1 文1：腹腔镜胆囊切除术中胆管损伤3例分析 1 1 临床资料 2 2 讨论 4 文2：腹腔镜胆囊切除术主胆管损伤及时处理体会 8 1 资料与方法 8 2 结果 10 3 讨论 10 参考文摘引言： 12 原创性声明（模板） 13 文章致谢（模板） 13 正文 腹腔镜胆囊切除术中胆管损伤3例分析 文1：腹腔镜胆囊切除术中胆管损伤3例分析 Analysis of 3 cases of bile duct injury during laparoscopic cholecystectomy HUANG Xun-bo，CHEN Qiao-feng，PAN Hong，et of Surgery，Shanghai Jiaotong Univeity Affiliated Luwan branch of Ruijin Hospital，Shanghai 200020，China ［Abstract］ Objective To explore the characteristics and management of bile duct injury during laparoscopic Clinical data of 3 cases of bile duct injury during laparoscopic cholecystectomy were analyzed Three cases had traection injury of biliary cases were found during the operation and 1 case was found after the cases received bile duct repair（end-to-end anastomosis） and T-tube supporting and drainage；1 case underwent chole-enteroanastomosis（Roux-en-Y）.All the cases were To find the injury of biliary duct in time during the operation is very important for avoiding serious results of treating the injury of biliary duct lies on the time when repair the injury. ［Key words］ laparoscopic cholecystectomy；bile duct injury；prevention；treatment 自1987年法国Mouret医生首次完成人体腹腔镜胆囊切除以来，腹腔镜胆囊切除术（Laparoscopic cholecystectomy，LC）因其创伤小、恢复快、痛苦轻、腹部瘢痕小及美容等优点，已被医患广泛接受。但近年由于胆囊疾病发生率的增加和腹腔镜手术的普及，因胆囊切除手术所致的胆道损伤逐渐增多［1］。胆道损伤是腹腔镜胆囊切除术最为常见的严重并发症，处理往往较为困难且后果严重。国内外 文献 报道其胆管并发症明显高于开腹胆囊切除术［2］。我们回顾分析了我院发生的3例腹腔镜胆囊切除术中胆管损伤的临床资料，现报告如下。 1 临床资料 例1，女，38岁。反复右上腹疼痛2年入院。超声检查示胆囊长 cm，宽 cm，壁厚 cm，囊内可见数枚强光团，最大 cm；胆总管内径 cm。腹腔镜术中见Calot三角脂肪组织堆积，分离胆囊管后，置夹切断；继续向上分离，胆囊动脉及周围组织大块施夹离断。随后在进一步的分离中见术区不断有胆汁溢出，立即中转开腹。探查发现胆总管离断，肝外胆管（右肝管）节段性缺损 cm，切除胆囊后行右肝管修补，取出胆总管断端的塑料夹行胆总管端端吻合，其下纵行切开置T管并使长臂通过吻合口支撑。术后6个月造影示通畅，拔除T管。随访1年，恢复良好，无不适。 例2，男，50岁。剑突下疼痛1个月余入院。超声检查示胆囊长 cm，宽 cm，壁厚 cm，囊内可见数枚强光团，最大 cm；胆总管内径 cm。腹腔镜下见胆囊积液，Calot三角致密黏连，胆总管、肝总管显示不清，用电钩分离三角区，发现分离困难，且在分离过程中术区不断有胆汁溢出，立即中转开腹。探查发现胆囊颈部结石嵌顿，并嵌入胆总管2/3，将胆囊部分切除并取尽结石后，发现肝总管也有部分因电凝所致缺损约 cm，胆总管受压坏疽约 cm，行肝总管修补，切除胆总管坏疽段后行胆总管端端吻合，其