腹腔镜胆囊切除术致胆管的热力损伤  

Bile duct heat injury caused by laparoscopic cholecystectomy

作　　者：王敬民[1] 鲍恩武[1] 徐义仁[1] 刘其春[1] 姜世涛[1] 龚仁华[1] 

机构地区：[1]武警安徽省总队医院外一科,合肥市230041

出　　处：《中华肝胆外科杂志》2004年第2期105-107,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的　探讨腹腔镜胆囊切除术致胆管热力损伤的原因、特点、处理及预防方法。方法　回顾总结我院 1992～ 2 0 0 2年间收治的腹腔镜胆囊切除术致胆管热力损伤的 8例临床资料。结果　 6例表现为穿孔性损伤 :右肝管损伤 1例 ,肝总管损伤 4例 ,胆总管损伤 1例 ,经过 1次或 1次以上手术治疗后痊愈 ;2例表现为延迟性胆管狭窄 ,均为肝总管损伤 ,再次手术后痊愈。随访 1 5～ 9年 ,无胆管狭窄。结论　与机械性胆管损伤相比 ,腹腔镜胆囊切除术致胆管热力损伤具有一定的特点 ,且其病情复杂、处理困难、处理方法灵活多样 ;娴熟的腹腔镜技术、正确掌握中转开腹指征以及丰富的胆道外科经验是预防和处理胆道热力损伤的关键。Objective To investigate the reasons, features, management and prevention of bile duct heat injury caused by laparoscopic cholecystectomy (LC). Methods The clinical data of 8 patients with LC-caused bile duct heat injury treated in our hospital from 1992 to 2002 were retrospectively analyzed. Results Six patients with manifestation of perforation injury were cured by one or more than one operations. Two patients with the manifestation of delayed bile duct stricture were cured by one operation. No biliary stricture occurred during the follow-up period of 1-9 years. Conclusions Bile duct heat injury caused by LC is different from the mechanic bile duct injury. Its state of illness is complex and its management is difficult, multiple and flexible. Skilled laparoscopic technique, precise treatment of the conversion to open operation and rich experience are important for prevention and treatment of the injury.

关 键 词：腹腔镜胆囊切除术 胆总管损伤 胆管狭窄 痊愈 肝总管 处理 腹腔镜技术 延迟性 穿孔性 右肝管损伤 

分 类 号：R657.4[医药卫生—外科学]