腹腔镜胆囊切除术中肝外胆管损伤的因素分析及对策

摘要

Objective To reduce or prevent the incidence of bile duct injury in the laparoscopic cholecystectomy,and reduce the postoperative complications of Bile duct injury in the laparoscopic cholecystectomy by time and exact treatment during the surgical procedure.Methods We retrospectively analyzed the clinical data of 8700 cases of LC, including 12 cases of bile duct injury, from September 1991 to today. The corresponding treatment was used in LC to avoid bile duct injury, when bile duct injury occurred, the injury was recognized and immediately repaired by surgery. Result The mean follow-up period after surgery was 5-10 years,all 12 patients with bile duct injury were cured and discharged. Conclusions We should correctly handle the relationship of various duct and avoid burn or cut duct for reducing incidence of the extrahepatic bile duct injury. Correct treatment can reduce or avoid the incidence of postoperative complications.%目的：减少或防止腹腔镜胆囊切除术中肝外胆管损伤的发生率．对术中已发生的肝外胆管损伤能及时、正确地进行补救处理，以尽可能减少术后并发症的发生．方法回顾分析本组自1991年9月至2013年7月腹腔镜胆囊切除术8700余例，其中发生肝外胆管损伤12例的临床资料，发生率为0.13%．术中采用正确的处理方法分辨各管系的关系，尽可能地避免损伤．如已经发生损伤，需及时发现，认真分析肝外胆管损伤的类型及部位，进行妥当的手术修补或端端吻合，放置引流．结果本组12例全部治愈出院，5～10 a随访恢复良好．结论腹腔镜胆囊切除手术中需要谨慎处理各管系的关系，不要盲目离断、灼烧管道，以尽可能避免损伤肝外胆管；对已发生的肝外胆管损伤需及时发现；术中得到正确的手术处理，可减少或避免术后并发症的发生．