Prevention of Biliary Duct Injury During Laparoscopic Cholecystectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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郑元超 , 夏焱 , 黄明哲

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Keywords：

胆囊切除术; 腹腔镜; 胆管损伤; 预防

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目的探讨如何预防腹腔镜胆囊切除术(LC)中的胆管损伤。
方法回顾性分析2006年1月至2008年12月期间在我院行LC的657例患者的临床资料，总结预防胆管损伤的经验。
结果 651例患者完成LC，中转开腹手术6例(0.91%)，其中1例(0.15%)因Calot三角致密粘连误伤胆总管。术后胆囊床毛细胆管渗漏2例，每日经腹腔引流管引出胆汁性液体20～50 ml，7～10 d 治愈出院。术后578例（包括中转开腹6例）患者获随访,随访率为87.98%，随访时间为2～24个月, 平均14个月。23例患者剑突下隐痛, 4个月内均自行消失，其余患者均未发现并发症。
结论严格掌握手术适应证、正确仔细地处理Calot三角和适时中转开腹是预防LC术中胆管损伤的关键。

Citation： 郑元超,夏焱,黄明哲. Prevention of Biliary Duct Injury During Laparoscopic Cholecystectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(8): 851-853. doi: Copy

1.	保红平, 方登华, 高瑞岗, 等. 腹腔镜胆囊切除术后胆漏的原因及处理 [J]. 肝胆外科杂志, 2001; 9(6): 432433.
2.	黄晓强, 冯玉泉, 黄志强. 腹腔镜胆囊切除术的并发症(附39 238例分析) [J]. 中华外科杂, 1997; 35(11): 654656.
3.	McMahon AJ, Fullarton G, Baxter JN, et al. Bile duct injury and bile leakage in laparoscopic cholecystectomy [J]. Br J Surg, 1995; 82(3): 307313.
4.	王俭, 安宁, 郑波, 等. 腹腔镜胆囊切除术中不同类型胆管损伤的处理 [J]. 中国普外基础与临床杂志, 2008; 15(2): 128129.
5.	喻启玲. 腹腔镜胆囊切除术胆道损伤对病人术后远期生活质量的影响 [J]. 中国实用外科杂志, 2002; 22(7): 438.
6.	谭毓铨, 王贵民. 重视胆囊切除术所致胆道损伤 [J]. 中华肝胆外科杂志, 2005; 11(3): 150152.
7.	冉瑞图. 关于胆囊切除术的几点意见 [J]. 中国普外基础与临床杂志, 2008; 15(2): 8182.
8.	Lillemoe KD, Petrofski JA, Choti MA, et al. Isolated right segmental hepatic duct injury: a diagnostic and therapeutic challenge [J]. J Gastrointest Surg, 2000; 4(2): 168177.
9.	方弛华, 杨继震, 潘玉先．胆囊动脉变异与腹腔镜胆囊切除术 [J]. 中华外科杂志, 1999; 37(7): 445.
10.	Georgiades CP, Mavromatis TN, Kourlaba GC, et al. Is inflammation a significant predictor of bile duct injury during laparoscopic cholecystectomy? [J]. Surg Endosc, 2008; 22(9): 19591964.
11.	Krhenbühl L, Sclabas G, Wente MN, et al. Incidence, risk factors, and prevention of biliary tract injuries during laparoscopic cholecystectomy in Switzerland [J]. World J Surg, 2001; 25 (10): 13251330.
12.	Nuzzo G, Giuliante F, Giovannini I, et al. Bile duct injury during laparoscopic cholecystectomy: results of an Italian national survey on 56 591 cholecystectomies [J]. Arch Surg, 2005; 140(10): 986992.
13.	Detry O, De Roover A, Detroz B, et al. The role of intraoperative cholangiography in detecting and preventing bile duct injury during laparoscopic cholecystectomy [J]. Acta Chir Belg, 2003; 103(2): 161162.
14.	Yamashita Y, Takada T, Kawarada Y, et al. Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines [J]. J Hepatobiliary Pancreat Surg, 2007; 14(1): 9197.
15.	梁久银, 李凯琅, 但震宇, 等．腹腔镜胆囊切除术胆管损伤的因素及对策 [J]. 腹腔镜外科杂志, 2006; 11(6): 523524.
16.	何德海, 甘启祥, 杨益森, 等. 腹腔镜胆囊切除术并发症的诊断和治疗 [J]. 中国普外基础与临床杂志, 2009; 16(8): 661663.

1. 保红平, 方登华, 高瑞岗, 等. 腹腔镜胆囊切除术后胆漏的原因及处理 [J]. 肝胆外科杂志, 2001; 9(6): 432433.
2. 黄晓强, 冯玉泉, 黄志强. 腹腔镜胆囊切除术的并发症(附39 238例分析) [J]. 中华外科杂, 1997; 35(11): 654656.
3. McMahon AJ, Fullarton G, Baxter JN, et al. Bile duct injury and bile leakage in laparoscopic cholecystectomy [J]. Br J Surg, 1995; 82(3): 307313.
4. 王俭, 安宁, 郑波, 等. 腹腔镜胆囊切除术中不同类型胆管损伤的处理 [J]. 中国普外基础与临床杂志, 2008; 15(2): 128129.
5. 喻启玲. 腹腔镜胆囊切除术胆道损伤对病人术后远期生活质量的影响 [J]. 中国实用外科杂志, 2002; 22(7): 438.
6. 谭毓铨, 王贵民. 重视胆囊切除术所致胆道损伤 [J]. 中华肝胆外科杂志, 2005; 11(3): 150152.
7. 冉瑞图. 关于胆囊切除术的几点意见 [J]. 中国普外基础与临床杂志, 2008; 15(2): 8182.
8. Lillemoe KD, Petrofski JA, Choti MA, et al. Isolated right segmental hepatic duct injury: a diagnostic and therapeutic challenge [J]. J Gastrointest Surg, 2000; 4(2): 168177.
9. 方弛华, 杨继震, 潘玉先．胆囊动脉变异与腹腔镜胆囊切除术 [J]. 中华外科杂志, 1999; 37(7): 445.
10. Georgiades CP, Mavromatis TN, Kourlaba GC, et al. Is inflammation a significant predictor of bile duct injury during laparoscopic cholecystectomy? [J]. Surg Endosc, 2008; 22(9): 19591964.
11. Krhenbühl L, Sclabas G, Wente MN, et al. Incidence, risk factors, and prevention of biliary tract injuries during laparoscopic cholecystectomy in Switzerland [J]. World J Surg, 2001; 25 (10): 13251330.
12. Nuzzo G, Giuliante F, Giovannini I, et al. Bile duct injury during laparoscopic cholecystectomy: results of an Italian national survey on 56 591 cholecystectomies [J]. Arch Surg, 2005; 140(10): 986992.
13. Detry O, De Roover A, Detroz B, et al. The role of intraoperative cholangiography in detecting and preventing bile duct injury during laparoscopic cholecystectomy [J]. Acta Chir Belg, 2003; 103(2): 161162.
14. Yamashita Y, Takada T, Kawarada Y, et al. Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines [J]. J Hepatobiliary Pancreat Surg, 2007; 14(1): 9197.
15. 梁久银, 李凯琅, 但震宇, 等．腹腔镜胆囊切除术胆管损伤的因素及对策 [J]. 腹腔镜外科杂志, 2006; 11(6): 523524.
16. 何德海, 甘启祥, 杨益森, 等. 腹腔镜胆囊切除术并发症的诊断和治疗 [J]. 中国普外基础与临床杂志, 2009; 16(8): 661663.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Prevention of Biliary Duct Injury During Laparoscopic Cholecystectomy

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