胆囊切除术_腹腔镜；胆管损伤；处理_

腹腔镜胆囊切除术胆管损伤18例临床分析

http://www.100md.com 《腹腔镜外科杂志》 2006年第5期

胆囊切除术,腹腔镜；胆管损伤；处理,,胆囊切除术，腹腔镜；胆管损伤；处理,1资料与方法,2结果,3讨论,参考文献：

     【摘要】目的：分析腹腔镜胆囊切除术(LC)胆管损伤的原因及防治。方法：回顾分析我院18例LC胆管损伤患者的临床资料。其中2例为本院患者，余由外院转入。结果：本院中1例右副肝管侧壁损伤，1例右肝管侧壁损伤，均于术中发现行胆管修补T管引流。外院转入16例，中5例术后24～48h出现胆漏入院(2例行胆管端端吻合，T管支撑引流术；1例行钛夹取出T管引流术；2例胆管修补T管引流术)；11例为术后3～41d出现黄疸、发热、腹痛。MRCP、ERCP提示胆管连续性中断，肝内胆管扩张。2例术中局部炎症，水肿严重，3～4月后二期胆肠RouxenY吻合术，余9例行胆肠RouxenY吻合术。结论：LC胆管损伤原因主要为术者对LC的高风险认识不足，导致术中操作不当；加之胆道解剖变异及局部病理因素改变，常至胆管损伤。胆管损伤后的处理应根据患者全身情况，腹腔病理改变及胆道损伤程度和医疗技术决定手术方式。

    【关键词】胆囊切除术，腹腔镜；胆管损伤；处理

    Bile duct injury after laparoscopic cholecystectomy in 18 patients

    LI Yuehua，WANG Binhuang，LI Lichun,et al.

    Second Departement of Hepatobiliary Surgery，Second Affiliated Hospital，Kunming medical college，Kunming 650101，China

    【Abstract】 Objective:To analyse the causation and investigate the prevention and cure of bile duct injury after laparoscopic cholecystectomy(LC).Methods:Clinical data of 18 patients with bile duct injury after LC in our hospital was analysed retrospectively.There were 2 patients in our hospital and 16 patients from other hosptials.Results:Parietal of right subsidiary hepatic duct was injuried in 1 patient and parietal of right hepatic duct was injuried in another patient.They were repaired bile duct and T duct drainage in the first operation from our hospital.Bile duct injury were complicated after LC in 16 patients from other hosptials,and they were complicated by bile leak in 5 patients after 24 to 48 hours from the first operation,bile duct end to end anastomosis and T duct support drainage was used in 2 patients,extection titanium clip and T duct drainage was used in 1 patient,repaired bile duct and T duct drainage was used in 2 patients.Other 11 patients were complicated by jaundice,fever and bellyache after 3 and 41 days from the first operation.Discontious bile duct and outstretched bile duct in the liver were visioned by MRCP and ERCP.Secondary opreation of choledochojejunostomy was used in 2 patients because of local inflammation and oedema.Choledochojejunostomy was used in another 9 patients.Conclusions:The main causation of bile duct injury after LC are as follows.The first,the operator lacked the understanding of the laparoscope's primary risk and mistakenly operate.The second,the patient have bile duct anatomical aberrance and local pathologic causation.For treatment bile duct injury after LC we must accorded to the instance of the patient,the degree of bile duct injury,bile duct anatomical aberrance,local pathologic causation and the technic of the operator.The success of the first operation is the most important to the patient with bile duct injury after LC. ......

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