中国现代手术学杂志2017，Vol.21Issue(2)：90-93,4.DOI:10.16260/j.cnki.1009-2188.2017.02.003
腹腔镜胆管损伤157例处理及近期随访分析
Treatment and Analysis on Laparoscopic Bile Duct Injury in Short-term Follow-up: 157 Cases Report
摘要
Abstract
Objective To assess the treatment experience of bile duct injury due to laparoscopic cholecystectomy (LC).Methods 157 cases with bile duct injury due to LC were analyzed retrospectively in our hospital during January 2010 to July 2015.70 cases were found the bile duct injury during the LC and repaired and performed intra-operative end-to-end anastomosis immediately.87 cases were found postoperative obstructive jaundice and bile peritonitis,and were underwent multiple surgeries.Results The causes of bile duct injury were mis-excision or mis-ligation in 88 cases (56.0％),heat effect injury of electric coagulation of main extrahepatic bile ducts in 33 cases (21.0％),biliary tract variation in 20 cases (12.7％) and other reasons in 36 cases (22.9％).In the 55 patients performed basin type of hepatobiliary Roux-en-Y anastomosis,3 cases were found recurrent high stenosis (type Ⅳ) and died of biliary cirrhosis,and other 52 cases were cured during the 0.5 to 5 (mean 3) years follow-up after the surgery.T tube was indwelled in 102 cases and removed 3 months later.The bile duct stenosis occurred again and cured by Roux-en-Y choledochojejunostomy in 9 patients during 0.5 to 5 years follow-up.The other 93 cases lived well during 0.5 to 5 years follow-up.Conclusions The intra-operative bile duct injury associated with LC always occurred in complex cases.It appeared more difficulty to repair the biliary injury in the case of higher injured site,greater bile duct defect,more detailed bile duct diameter,more severer local inflammation,especially electric knife amputation or burning.Extensive clinical experience,adequate microsurgical consciousness,enough patience and perseverance is the key to successful surgery treatment.关键词
胆囊切除术,腹腔镜/胆管损伤Key words
cholecystectomy, laparoscopic/bile duct injury分类
医药卫生引用本文复制引用
刘昌军,黄飞舟,尹新民,毛先海,蒋波,周海兰,吴金术..腹腔镜胆管损伤157例处理及近期随访分析[J].中国现代手术学杂志,2017,21(2):90-93,4.基金项目
湖南省自然科学青年基金(2017JJ3172) （2017JJ3172）
