49例腹腔镜胆囊切除术所致医源性胆管损伤的处理

摘要

Objective To explore the opportunity and the approach of surgery in laparoscopic cholecystectomy-associated bile duct injury patients.Methods A retrospective medical record was collected in 49 patients who underwent surgical repair between January 2001 and December 2011.Univariate statistical analysis was used to identify risk factors for postoperative complications.Results 29 cases of hepaticojejunostomies,19 of choledochojejunostomies,and 1 of primary common bile duct repair were performed.10 received immediate repairs (0 ～72 hours post LC),27 received intermediate repairs (72 hours ～ 6 weeks),and 12 received late repairs (6 weeks later).15 patients developed short-term or long-term postoperative complications.Patients with intermediate repairs were more likely to develop biliary stricture than that of the immediate or late periods (P =0.03).Conclusions The timing of repair is an important determinant of long-term outcome.Repairs in the intermediate period were significantly associated with biliary stricture.Thus,repairs should be undertaken either in the immediate (within 72hours) or delayed (6 weeks later) periods after LC.%目的 探讨腹腔镜胆囊切除术所致胆管损伤的处理时机及疗效评价. 方法 回顾总结2001年1月至2011年12月期间我院收治的49例腹腔镜胆囊切除术所致医源性胆道损伤患者的临床资料,对损伤胆道的手术时机及其疗效进行分析. 结果 49例患者中,29例行肝管空肠Roux-en-Y吻合术,19例行胆管空肠Roux-en-Y吻合术,1例行胆总管修补术.10例在腹腔镜胆囊切除术后3d内再次手术,27例在3d～6周内再次手术,12例在6周后再次手术.15例患者出现不同的远期或早期并发症.统计学分析发现,在3d～6周内再次手术的患者较容易出现胆道狭窄(P=0.03). 结论 胆道损伤修复手术在胆道损伤后3d内或6月后施行可减少胆道狭窄的发生.