胆道变异与腹腔镜胆囊切除致胆管损伤——单中心17例的经验与体会  

Bile duct variation with the relationship of the bile duct injury in laparoscopic cholecystectomy: a single center report of 17cases

作　　者：龚仁华[1] 孙登群[1] 钟兴国[1] 孙艳军[1] 范育林[1] 蔡军[1] 何新苗[1] 曹葆强[1] 姜世涛[1] 鲍恩武[1] 李凯琅[1] 但震宇[1] 

机构地区：[1]武警安徽省总队医院武警部队腹腔镜外科治疗中心,合肥230041

出　　处：《肝胆外科杂志》2013年第3期200-202,共3页Journal of Hepatobiliary Surgery

摘　　要：目的探讨胆道变异时腹腔镜胆囊切除致胆管损伤的特点与防治方法。方法对我院2005.1.1～2013.1共进行腹腔镜胆囊切除术29881例,其中因胆道变异引起的胆管损伤17例,对其进行总结分析。结果损伤部位:肝门部副肝管损伤完全横断4例;副肝管部分损伤5例;胆囊床迷走胆管损伤4例;胆囊管开口在右肝管4例;损伤后处理:术中胆管发现13例:给予腔镜下处理3例、中转开腹修补+外引流10例;术后发现胆管4例,3例再次腹腔镜探查;1例右肝管完全横断伤,给予行内引流手术;术后胆漏2例,经过引流后治愈。结论胆道变异是导致腹腔镜下胆囊切除胆管损伤的重要原因,提高警惕,掌握合适的手术方法技巧,充分认清胆道变异的形式,掌握胆管损伤表现的各种形式,可以将这种损伤有效避免或将损伤的引起的严重后果降低到最低程度。Objective To investigate the injury causes, characteristics and prevention of bile duct variation during laparoscopic cholecystectomy （LC）. Method Retrospective analysis of the causes and treatment of variant bile duct damage in 29881 cases of LC in our unit from January 2005 to January 2013. We experienced 17 cases of variant bile duct injury. The experiences of treatment in these cases were sum up. Result In 17 cases, I3 cases were found during the operation and 4 after the operation. 6 cases were successfully repaired under laparoscope. The others were repaired under the open operation. The site of injury bile duct ： accessory hepatic ducts of portal of liver were completely fractured in 4 cases ;the damage to part of accessory hepatic duct in 5 cases; the aberrant ducts damaged in 4 cases ; Gallbladders were in charge of open defect in bile duct damage in 4 cases ; All of the 17 patients were cured and discharged from the hospital. Conclusion The variant bile duct can be damaged easily during the laparoscopic cholecystectomy, Mastering appropriate surgical methods, fully understand the performance of the damage of bile duct forms. This damage can be effectively avoided and the consequences of damage can be reduced to the minimum degree.

关 键 词：胆囊切除术 腹腔镜 胆道变异 胆管损伤 

分 类 号：R657.4[医药卫生—外科学]