目的:探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)致胆管损伤的原因、预防措施和经验教训。方法:分析2007年8月~2008年8月期间我院胆道外科收治的3例胆管严重损伤病例资料。结果:3例LC术致胆管严重损伤的患者均发生肝门部胆管狭窄,并均在肝门胆管成形后行胆管空肠Roux-en-Y吻合术,吻合口直径2.0~3.0 cm。术后患者恢复良好,均顺利出院,住院时间为10~15天。随访1~6个月,1例于术后2月出现肝区隐痛,口服消炎药可控制,其余未见异常不适。结论:术中仔细辩清肝总管、胆总管与胆囊管的三者关系是预防LC术胆管损伤的关键。胆管空肠Roux-en-Y吻合术是处理胆管损伤的重要手术方式。LC术时,胆道外科医生思想上要高度重视,不可盲目追求速度。
Citation:
ZHAO Dong,CHENG Nansheng,XIONG Xianze,et al.. Clinical Analysis of Severe Bile Duct Injury after Laparoscopic Cholecystectomy. West China Medical Journal, 2009, 24(1): 76-78. doi:
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范育林,龚仁华,徐正涛,等.腹腔镜胆囊切除术胆管损伤46例报告[J].中国微创外科杂志,2006,6(10):754-755..
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2. |
李立波,李君达,蔡秀军,等.影响腹腔镜胆囊切除术胆管损伤修复效果的因素[J].中华普通外科杂志,2003,18(5):263-265..
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3. |
刘夕强,黄原秋.肝内胆管结石的外科治疗[J].中国普通外科杂志,2006,15(3):221-223..
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4. |
高志清,付由池,刘正才.医源性胆管损伤的严重后果[J].中华肝胆外科杂志,2006,12(12):793-795..
|
5. |
Genevieve B,Melton MD,Keith D,et al.Major bile duct injury associated with laparoscopic cholecystecomyEffect of surgical repair on quality of life[J].Ann Surg,2002,235:888895..
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Djemila Boerma,PhD,Erika.J,Rauws,PhD,et al.Impaired quality of life 5 years after bile duct injury during laparoscopic cholecystectomyA prospective analysis[J].Ann Surg,2001,234:750-757.
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- 1. 范育林,龚仁华,徐正涛,等.腹腔镜胆囊切除术胆管损伤46例报告[J].中国微创外科杂志,2006,6(10):754-755..
- 2. 李立波,李君达,蔡秀军,等.影响腹腔镜胆囊切除术胆管损伤修复效果的因素[J].中华普通外科杂志,2003,18(5):263-265..
- 3. 刘夕强,黄原秋.肝内胆管结石的外科治疗[J].中国普通外科杂志,2006,15(3):221-223..
- 4. 高志清,付由池,刘正才.医源性胆管损伤的严重后果[J].中华肝胆外科杂志,2006,12(12):793-795..
- 5. Genevieve B,Melton MD,Keith D,et al.Major bile duct injury associated with laparoscopic cholecystecomyEffect of surgical repair on quality of life[J].Ann Surg,2002,235:888895..
- 6. Djemila Boerma,PhD,Erika.J,Rauws,PhD,et al.Impaired quality of life 5 years after bile duct injury during laparoscopic cholecystectomyA prospective analysis[J].Ann Surg,2001,234:750-757.