腹腔镜胆囊切除术中损伤性胆漏的原因及处理  

The cause and treatment of biliary fistula due to laparoscopic cholecystectomy

作　　者：朱家万[1] 宝宏革[1] 刘浩[1] 

机构地区：[1]常德职业技术学院附属第二医院,湖南常德415000

出　　处：《腹腔镜外科杂志》2009年第4期290-292,共3页Journal of Laparoscopic Surgery

摘　　要：目的：探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）所致医源性胆漏的成因及预防措施。方法：回顾分析2002年6月至2007年8月我院为659例患者行LC的临床资料,分析胆漏发生的原因。结果：本组发生胆管损伤5例,其中1例胆总管穿孔,1例钛夹脱落,1例胆总管实质横断,1例胆总管壁部分缺损,1例胆总管电灼伤,分别给予对症治疗后痊愈。随访2-3年,均恢复良好。结论：操作与经验的欠缺,技术不娴熟,思想麻痹大意,胆囊三角区炎症粘连、解剖不清是造成胆漏的重要原因,我们利用吸引器钝性分离三角区解剖层面,顺逆结合法切除胆囊。术前MRCP及ERCP检查及术中造影是防止LC医源性胆漏的有效手段。同时应做好中转开腹的思想准备。Objective：To explore the cause and prevention of biliary fistula due to laparoscopic cholecystectomy （LC）. Methods ： The clinical data of 659 cases that underwent LC from Jun. 2002 to Aug. 2007 in our hospital were analyzed retrospectively to find the cause of biliary fistula. Results：Biliary duct injury occurred in five cases. There were one case of common bile duct perforation,one desquamation of titanium clip ,one common bile duct transsection, one partial deletion of common bile duct and one case of electricalburn in common bile duct. The five patients had complications recovered after symptomatic treatment. All the 659 patients underwent LC recovered well during follow-up period in 2-3 years. Conclusions ： Defection of operation experience, impatient and unskillful procedures, hard to identify the anatomical structure due to adhesions in Calot＇s triangle might be the most important reasons of biliary fistula complicated in LC. Surgeons should use absorber to dissect tissue in Calot＇s triangle and strip gallbladder anteriorly and posteriorly. The MRCP and ERCP examination should be helpful to prevent the biliary fistula. Meanwhile, preparation of converting to traditional operation is also necessary.

关 键 词：胆囊切除术 腹腔镜 胆管损伤 胆漏 

分 类 号：R657.4[医药卫生—外科学]