应用“胆总管窗”行腹腔镜胆囊切除术  

Application of'Common bile duct window'in laparoscopic cholecystectomy

作　　者：邓代安[1,2] 叶辉[1] 李宁[1] 鲁稳柱[1] 

机构地区：[1]四川大学华西医院普外科,成都610041 [2]四川省安丘县人民医院肝胆外科

出　　处：《中华腔镜外科杂志（电子版）》2010年第3期43-45,共3页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的探讨"胆总管窗"在腹腔镜胆囊切除术中的应用价值。方法选择2009年6月1日至2009年10月31日期间行腹腔镜胆囊切除的患者55例,以"胆总管窗"为标志行腹腔镜胆囊切除术,观察术中"胆总管窗"以及肝总管和胆总管在肝门与"胆总管窗"连线的出现率,分析肝总管、胆总管、胆囊管与肝门至"胆总管窗"连线的关系。结果 "胆总管窗"的出现率为92.7%(51/55),98%肝总管和胆总管位于肝门与"胆总管窗"的连线上,并能被显露,胆囊管位于此线右侧。在胆囊急性炎症发作时,肝十二指肠韧带炎症水肿明显,大多数患者仍能观察到"胆总管窗"。结论运用"胆总管窗"作为解剖标志,在肝门与"胆总管窗"的连线上显露肝总管和胆总管,能够很好地显示肝总管、胆总管、胆囊管之间的关系。以"胆总管窗"为标记进行操作,有助于降低腹腔镜胆囊切除术中胆管损伤的发生率。Objective To explore the application of ＂common bile duct window＂ in laparoscopic cholecystectomy. Methods Fifty-five cases of patients who underwent laparoscopic cholecystectomy between June 1, 2009 to October 31, 2009 were included. The concept of common bile duct window was applied in the procedure of laparoscopic cholecystectomy. Appearance rate of common bile duct window and hepatic duct and common bile duct in the hepatic hilum and common bile duct window line were observed intraoperatively. The relationship of hepatic duct, common bile duct, cystic duct and hepatic hilum-common bile duct window line were analyzed. Results The occurrence rate of common bile duct window was 92.7 % （51/55）, 98 %（50/51） of the hepatic duct and common bile duct were in the hepatic hilum and common bile duct window line and can be exposed, the cystic duct was located in the right side of this line . In the circumstance of acute cholecystitis, the common bile duct window can still be visualized in most patients even significant inflammatory changes occurred in the hepatoduodenal ligament. Conclusions The relationship between hepatic duct, common bile duct and cystic duct can be better understood by using common bile duct window as an anatomical landmark to dissect hepatic duct and common bile duct. The application of common bile duct window can reduce the incidence of bile duct injury in laparoscopic cholecystectomy.

关 键 词：腹腔镜胆囊切除术 胆管损伤 胆总管窗 

分 类 号：R657.4[医药卫生—外科学]