术中胆道造影在腹腔镜胆囊切除术中发现胆道损伤的作用  

Intraoperative diagnosis of bile duct injury by cholangiography during laparoscopic cholecystectomy

作　　者：李立波[1] 蔡秀军[1] 李君达[1] 牟一平[1] 王先法[1] 王跃东[1] 袁晓明[1] 魏琪[1] Finley RK 

机构地区：[1]浙江大学医学院附属邵逸夫医院普外科,杭州310016 [2]美国罗马琳达大学普外科

出　　处：《中华普通外科杂志》2002年第1期50-51,共2页Chinese Journal of General Surgery

摘　　要：目的评估术中胆道造影 (IOC)在早期发现腹腔镜胆囊切除术 (LC)术中胆道损伤的作用。方法回顾分析 31例LC术后胆道损伤的部位、机理、诊断时间、治疗方法及结果 ,并对是否行IOC进行评估。结果胆道错认引起胆道损伤共 19例 ,其中 12例IOC显示胆道错认 ,致胆道部分切开损伤 ,腹腔镜下行Ⅰ期修复或开腹修复、T管引流 ,但无并发症 ;19例中 3例IOC误读及 4例未行IOC患者中发生迷走胆管损伤 2例 ,胆总管完全离断 1例 ,胆总管完全离断合并胆道缺损 2例。本组有 2例损伤发生于IOC后。结论行IOC并正确阅读可及时发现腹腔镜胆囊切除术中胆道错认所致的胆道损伤 。ObjectiveTo assess the value of intraoperative cholangiography(IOC) for detecting bile duct injury during laparoscopic cholecystectomy.Methods31 cases of bile duct injuries were reviewed regarding the site of injury,mechanism,time of diagnosis,and the place of IOC was evaluated.ResultsBile duct injuries resulted from misidentification in 19 cases.In 12 of these 19 cases,the diagnosis was made by IOC.Primary laparoscopic repair or open repair and T-tube drainage solved the problem without postoperative complications.However,in 3 of the above 19 cases the result of IOC was misinterpreted and in 4 of the above 19 cases IOC was not performed.Two of the 7 patients had aberrant bile duct injuries, in all of them the diagnoses were delayed.There were two cases in which bile duct injury developed after an IOC.ConclusionsCorrect interpretation of IOC enables detecting bile duct injury caused by intraoperatively misidentification and consequent morbidity.

关 键 词：胆管造影术 监测 手术中 腹腔镜胆囊切除术 IOC LC 

分 类 号：R657.4[医药卫生—外科学]