腹腔镜胆囊切除术中对胆囊管及胆囊三角区内肝外胆管结构变异的辨认和处理策略  

Management and recognition of anatomical variation of cystic duct and extrahepatic bile duct of Calot's triangle in laparoscopic surgery

作　　者：罗昆仑[1] 方征[1] 董志涛[1] 余峰[1] 

机构地区：[1]中国人民解放军第101医院(南京军区腹腔镜外科中心),江苏无锡214044

出　　处：《中国内镜杂志》2009年第11期1211-1213,1216,共4页China Journal of Endoscopy

摘　　要：目的通过在腹腔镜下对胆囊管及胆囊三角区内肝外胆管结构变异的认识,探讨手术处理胆囊三角区结构变异的最佳方式。方法回顾性分析该院2006年12月～2009年6月行腹腔镜胆囊切除术(LC)术中所见胆囊管及胆囊三角区内肝外胆管结构变异患者90例的临床资料,分别针对胆囊管变异、胆囊管汇入胆总管位置变异和胆囊三角区内肝外胆管结构变异等情况进行不同的手术操作。结果全组90例,术中中转开腹14例(包括Mirizzi综合征Ⅰ型4例Ⅱ型4例全部中转;胆囊管汇入胆总管过低2例;胆囊管开口于胆总管后壁2例;胆囊管与胆总管共同一侧壁,并并行约2 cm 1例;右肝管汇入胆囊管1例,开腹术中证实)。LC术成功76例。术后并发症2例,其中LC术后1周因胆囊床迷走胆管渗漏胆汁再次手术1例,胆管残留结石1例(术后2周经ERCP取出结石)。19例文氏孔放置引流管引流,术后2～5 d拨除。全部病例均临床治愈出院。结论熟悉胆囊管及胆囊三角区内肝外胆管结构变异,细致解剖胆囊三角区,辨清肝总管、胆总管位置,针对不同的变异采用不同的操作方法,是LC手术成功的关键。[Objective] To summarize the recognition of anatomical variation of cystic duct and extrahepatic bile duct of the Calot＇s triangle and investigate the best method for management of the variation in the Calot＇s triangle during laparoscopic cholecystectomy（LC）. [ Methods ] Totally 90 cases with anatomical variation in the Calot＇s triangle by LC from December 2006 to May 2009 were retrospectively analyzed. Different operative procedures were practiced respectively for the variation of the cystic duct, extrahepatic bile duct and the location of cystic duct into the common bile duct of Calot＇s triangle because of dense adhesions. [ Results] There was no death in any patient. Seventy-six cases were treated with LC. Fourteen cases were converted to laparotomy （including 4 cases of type Ⅰ Mirizzi syndrome, 4 cases of type Ⅱ which all converted to laparotomy. 2 cases with the location of cystic duct into the common bile duct much lower than normal one,2 cases with the confluence of cystic duct and choledoch locating in the posterior wall of choledoch. 1 case with a public wall shared for about 2 cm between the cystic duct and the choledoch）. Postoperative complications occurred in 2 cases： bleeding of puncture hole in 1 case, residual stone of bile duct in 1 case （residual stones were taken out by ERCP 2 weeks after operation）. Drainage tube were placed in the Venturi hole in 19 cases, and taken out 2-5 days after operation. All cases were clinically cured and discharged. [ Conclusions ] Knowledge of the Calot＇s triangle anatomical variations, careful dissection of Calot＇s Triangle area, discrimination of the location of common hepatic duct and common bile duct, and different operation methods for different variations, are all critical to the success of LC.

关 键 词：胆囊管变异 肝外胆管变异 腹腔镜 胆囊切除术 

分 类 号：R657.4[医药卫生—外科学]