巴明臣 安治国 毛静熙 陈训如 巴明臣、毛静熙、陈训如 成都军区昆明总医院肝胆外科 昆明 650032; 安治国 内蒙古自治区医院普外科 中华消化内镜杂志 1999 0 16 5


    关键词：胆囊切除术；肝外胆管；横断损伤 期刊 zhxhnjzz 0 论 著 fur -->


    

摘要 目的 探讨腹腔镜胆囊切除术中肝外胆管横断损伤发生的原因及预防措施。方法 回顾分析了6 000例腹腔镜胆囊切除术中9例肝外胆管横断损伤的原因，探讨了预防肝外胆管横断损伤的措施。结果 指出Calot三角解剖结构不清或存在解剖变异，误把胆总管当胆囊管钳夹、切断是肝外胆管横断损伤的主要原因。结论 严格掌握手术适应证，沿胆囊壶腹向下分离，仔细辨别Calot三角解剖结构，术中始终想着Calot三角解剖结构存在的变异，避免盲目自信、莽撞行事是预防肝外胆管横断损伤的关键。

    

Laparoscopic bile duct injuries: causative factors and preventive tactics

BA Mingchen^* , AN Zhiguo, MAO Jingxi, et al.

    ^* Department of Hepatobiliary , Kunming General Hospital, Chengdu Military Region, Kunming 650032

Abstract Objective Accidental transectional injuries of extrahepatic bile ducts may occur in laparoscopic cholecystectomy (LC) . The probable causes and preventive measures were investigated in this report. Methods The study was based on retrospective review of 10 cases with such injuries encountered within past 7 years out of 6000 LC in our hospital. Results It was shown that the main factor leading to transecting the ducts might lie in anatomic or pathologic alteration or anomaly of ductal system at Calot’s triangle, thereby the common bile duct might be mistaken for the cystic duct which was to be clipped and cut in procedure. Conclusion Tactics to avoid such accident were summerized as follows: strict handling of indications for LC; persistent memory of variations of bile ductal system at Calot’s triangle either congenital of pathological; careful recognition and verification of relations among ducts prior to each cut ; retrograde dissection of cystic duct , whenever possible; meticulous manipulation instead of rough operation.

    Key words Cholecystectomy Extrahepatic bile duct Transectional injury

肝外胆管横断损伤是腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)后最严重的并发症之一 ......