腹腔镜胆道修复重建术治疗腹腔镜胆囊切除术中的胆管损伤  

Laparoscopic bileduct repair and reconstruction for bile duct injuries during laparoscopic cholecystectomy

作　　者：李建军[1] 卢榜裕[1] 蔡小勇[1] 黄玉斌[1] 江文枢[1] 陆文奇[1] 刘祖军[1] 黄飞[1] 靳小建[1] 晏益核[1] 雷宇[1] 陈永军[1] 蒙元彪[1] 陈继安[1] 

机构地区：[1]广西医科大学第一附属医院西院普通外科,微创外科,南宁53000

出　　处：《中华腔镜外科杂志（电子版）》2013年第2期10-15,共6页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的腹腔镜手术出现胆管损伤后通常需要中转开放手术修复或二期手术，给患者增加极大的痛苦。能否采用腹腔镜手术的方法修复胆管损伤是一个值得探讨的问题。本研究的目的是探讨腹腔镜修复术治疗术中和术后早期发现的医源性胆管损伤的方法和可行性。方法总结分析2002年11月至2012年12月采用腹腔镜修复重建术治疗的11例术中或术后早期发现的医源性胆管损伤的资料。11例发生在腹腔镜胆囊切除术中（11／1485，0．74％）。男7例，女4例，平均年龄57．4岁（26～70岁）。其中6例为胆管轻度损伤，5例为高位胆管横断的重度胆管损伤。按刘允怡分类法，11例胆管损伤的损伤类型分别是：I型2例，ⅡA型2例，IIIA型2例，ⅣA型3例，ⅣB型2例。9例胆管损伤在术中发现，另2例在术后2d发现。针对不同的损伤类型采用不同的修复方法。2例肝总管部分轻度损伤（UA型）的患者采用镜下缝合修补、T管引流来修复g1例右肝管孔状损伤的患者采用镜下单纯缝合修复；1例胆总管误扎的患者在镜下松解结扎线、胆总管探查、T管引流；1例胆囊床迷走小胆管横断的患者镜下缝扎封闭；1例胆囊颈残余胆漏的患者采用镜下切除残余胆囊、缝扎胆囊管的方法修复；另外5例高位胆管横断伤（肝总管或者左、右肝管横断伤）的患者采用镜下损伤的胆管对端吻合、硅胶支架管内引流的方法修复。结果11例胆管损伤（BDI）患者均完全腹腔镜下一期修复术，无中转开腹手术。术后患者恢复顺利，无腹腔感染、无伤口感染等并发症发生。胆管修复术后平均住院时间是8．9d（5～15d）。患者均获得随访，随访时间8个月-10年不等。11例患者均无胆管狭窄。有1例患者发生过一次胆管炎，CT发现胆总管轻度扩张，行经内镜逆行性胰胆管造影术检查未发现胆总管结石，无胆管狭窄、肿瘤�Objective Conversion to open surgery or two-stage operations were often needed when bile duct injuries （BDI） occurred, which would cause more pain to patients. It is worth to explore whether laparoscopic repair are suitable for BDI. The aim of the study is to explore the methods and feasibility of laparoscopic bileduct repair and reconstruction for BDI found during operation and in early postoperative period. Methods From Feburary 2002 to December 2012, 11 patients with BDI were treated with laparoscopic repairs during operation or in early postoperative period. The clinical data were collected and analyzed. 11 cases of BDI occurred in laparoscopic cholecystectomies （11/1485, 0.74%）. 7 patients were male, and 4 patients were female. The mean age was57.4 years （range 26-70 years）. 6 BDI were mild injuries, and other 5 BDI were severe injuries （high-level bile duct transection ）. Wan-Yee Lau classification was used for these 11 BDI. 2 cases fell into type 1,2 into II A,2 into mA,3 into 1VA,2 into IVB. 9 BDI were found during operation, and the other 2 BDI were found on the second postopevative day. Different methods were used to repair BDI according to the type and severity of BDI.Laparoscopic suture and T-tube drainage were carried out in 2 mild partial common hepatic duct injuries （type II A ）. Laparoscopie simple suture was performed in one patient with a hole-like injury in the right hepatic duct （type 1VA）. Laparoscopie common bile duct exploration, T-tube drainage , unfastening the thread were performed in one patient whose common bile duct was ligated incorrectly （type IliA ）. Laparoseopic closure by simple suturing was performed in one patient whose aberrant small bile duct at the gallbladder bed of live was injured （type I ）. The retained neck of gallbladder was reseeted and the cystic duct was sutured laparoscopically in one patient with retairied neck of gallbladder and bile leak. Laparoscopic end-to-end bile duct anastomosis with silicone tube internal drainage were perfo

关 键 词：胆管损伤 腹腔镜 修复 腹腔镜胆囊切除术 胆道外科 

分 类 号：R657.4[医药卫生—外科学]