腹腔镜胆囊切除术胆管损伤的防治

目的避免腹腔镜胆囊切除术胆管损伤的发生。方法回顾分析本院自1999年1月～2005年11月腹腔镜胆囊切除术512例。结果胆管损伤4例。结论严格的术前准备和规范的手术程序可以极大地减少腹腔镜胆囊切除术胆管损伤的发生。     

腹腔镜胆囊切除术中胆管损伤的分析

随着腹腔镜胆囊切除术 (ＬＣ)的广泛开展 ,其手术并发症也日益受到关注。尤其是ＬＣ术中所引起的胆管损伤 ,作为ＬＣ术中严重并发症的一种 ,各医疗单位也在不断地探讨有效的预防和处理的措施 ,但结果并未像ＬＣ初期所预料的那样 ,胆道损伤的发生率并未完全随着ＬＣ开展数量的增加而消失 ,而是稳定在一定水平上〔1〕。因此 ,我们仍有必要在ＬＣ开展初期总结的胆道损伤处置经验的基础上 ,进一步分析ＬＣ大量开展后胆道损伤的具体原因和处理措施。临床资料本文总结ＬＣ所致胆道损伤共 14例 ;其中来源于我院 34 0 0例 ( 1992～ 2 0 0 1年 )ＬＣ…     

腹腔镜胆囊切除术中肝外胆管损伤的原因与预防

1991．9～1994.3月我院共做LC1750例，发生肝外胆管损伤4例，胆囊管残端瘘1例，迷走胆管损伤1例，外院转入LC术中胆管损伤2例，本文讨论LC术中肝外胆管损伤发生的原因及预防：(1)把胆总管误认为胆囊管将其钳闭切断，本组3例。     

腹腔镜胆囊切除术中胆管损伤的预防

目的 探讨腹腔镜胆囊切除术中胆管损伤的预防措施.方法 回顾性分析2002年12月～2007年12月484例腹腔镜胆囊切除术患者的临床资料,总结预防胆管损伤的经验.结果 本组患者无胆管损伤发生,中转开腹26例(5.37%),放置腹腔引流管20例.结论 熟悉胆管解剖,仔细地处理胆囊三角是避免LC术中胆管损伤的关键.     

腹腔镜胆囊切除术胆管损伤的护理

通过对７例腹腔镜胆囊切除术胆管损伤病人的护理，总结了腹腔镜胆囊切除术后加强对漏胆、腹腔感染、黄疸等胆管损伤的临床症状的观察，重点阐述了Ｔ形管的护理是胆管损伤重建手术后的护理重点。     

腹腔镜胆囊切除术胆管损伤的防治

本院自１９９７年开展腹腔镜下胆囊切除术以来，胆管损伤时有发生。如何预防及正确处理腹腔镜胆囊切除术中胆管损伤，现将笔者的体会报告如下。临床资料１．一般资料：本组１０例，其中男性４例，女性６例；年龄３８～６９岁，平均５１岁。损伤部位：胆总管横断伤２例，胆总管裂开或缺损伤３例，钛夹钳夹胆囊管时胆总管误夹３例，右肝管裂伤２例。其中７例于术中发现，３例术后发现。２．结果：所有病例均进行及时正确处理，无一例死亡。其中１例病人术后仍间断出现腹痛、发热、黄疸等胆道感染症状，其余病人恢复良好。讨论胆石症是目前的常…     

腹腔镜胆囊切除术致胆管损伤5例分析

自腹腔镜胆囊切除术(LC)引进我国后,因其安全、经济、创伤小、恢复快,且适应证广被医患双方认可,广泛应用于临床。我院自2002年6月-2004年6月共开展LC216例,其中损伤胆管5例,现总结分析如下：     

腹腔镜胆囊切除术中的胆管损伤

腹腔胆囊切除术已广泛开展，经总结它也有一定的并发症，其中以胆管损伤尤为严重，兹就其发生率、损伤发展、希机因素、发生原因以及其防治措施加以重点介绍。     

腹腔镜胆囊切除术中胆囊床胆管损伤的处理

目的探讨预防及处理腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）时胆囊床胆管（包括右肝管分支及迷走胆管）损伤的对策。方法回顾性分析1997年1月～2004年12月2032例LC中15例胆囊床胆管损伤的临床特征、处理方法及效果。结果5例为慢性结石性胆囊炎急性发作，10例为慢性结石性萎缩性胆囊炎。8例右肝管分支损伤，7例迷走胆管损伤。8例用钛夹夹闭损伤胆管，5例缝合损伤胆管，另2例由于裂口较大且靠近右肝管主干而行开腹胆管修补术。术后胆漏1例，引流5d后痊愈。随访半年～3年，平均23个月，症状消失，无黄疸及胆管炎等并发症发生。结论预防胆囊床处胆管损伤的关键是紧贴胆囊壁剥离胆囊，术中及时发现并采用恰当的处理方法可获得较好的结果。     

LC引起的医源性右肝管、副肝管损伤的诊治

目的 分析腹腔镜胆囊切除术（LC）造成的医源性右肝管、副肝管损伤的特点及防治,探讨术中胆道造影（intraoperative cholangiography,IOC）对术后胆道通畅度评级的影响。方法 回顾性分析南京医科大学第一附属医院2014年5月至2021年11月诊治的20例医源性右肝管、副肝管损伤患者的损伤类型和损伤原因、治疗及随访结果。20例中11例未行术中胆道造影（非IOC组）,9例行术中行胆道造影（IOC组）,对比两组术后胆道通畅度评级。结果 右肝管损伤16例：8例行I期修补置管支撑引流,其中5例双T管置入;4例单纯修补;3例右肝管横断延期行胆肠吻合术;1例右肝管误缝扎,远期因梗阻行胆肠Roux-en-Y吻合术失败改行PTCD。4例副肝管损伤中1例修补并置管引流,1例术中误夹闭后胆瘘二期行胆肠吻合术,2例直接夹闭。IOC组术后胆道通畅度评级A级8例、C级1例,非IOC组GP A级3例、B级4例、C级3例、D级1例;IOC组评级优于非IOC组（P<0.05）。术后随访6~133个月,远期右肝管结石形成2例,胆管炎3例,右肝萎缩1例。结论 充分认识右肝管及副肝管的解剖特点,术中及时发现损伤,并根据损伤类型、IOC情况等制定相应策略是提高LC医源性胆管损伤疗效的关键。     

Biliary tract injury in laparoscopic cholecystectomy: results of a single unit

Background: Laparoscopic cholecystectomy was introduced into Australia in early 1990. Its rapid increase in acceptance was, however, tempered by reports of an increased incidence of bile duct injury. The aim of this study was to report on the incidence of biliary tract injuries in a single unit, comment on the way they were managed and look at strategies to prevent them. Methods: A retrospective audit was conducted on laparoscopic cholecystectomies performed between January 1992 and March 2001. The data was collated from patient medical record files and yielded a total of 1216 procedures. Results: There were 899 women (74%) and 317 men (26%), with an age range of 13?92 years. Most of the procedures were performed on an elective (94%) rather than emergent basis (6%). There was one bile duct injury (0.09%) and seven bile leaks (0.63%). The single injury involved common bile duct obstruction by a misplaced clip and was successfully managed by chol­angio‐enteric bypass. Of the seven bile leaks, three were from the cystic duct stump, two from the gallbladder bed, and two were unidentified, settling conservatively. Of the five patients actively treated, two underwent therapeutic laparoscopy, two proceeded to laparotomy, and one was managed successfully by endoscopic stenting. Conclusions: Single‐centre studies such as this are important in ensuring that standards of surgery are maintained in a community setting.     

843例腹腔镜胆囊切除术手术体会

目的　总结分析腹腔镜胆囊切除术 (laparoscopiccholecystectomy ,LC)中Calot三角的解剖并探讨如何预防LC中胆管损伤。方法　回顾性分析 2 0 0 1年 3月～ 2 0 0 1年 8月完成的LC手术 84 3例。结果　完成LC手术 82 6例 ,手术成功率 97.98% ,中转开腹 17例 ,中转率 2 .0 2 % ,迟发性胆囊管残端胆漏 1例 ,无胆管损伤、术后腹腔内出血等其它并发症。结论　良好的胆道外科意识、科学的解剖方法和精细的手术操作是避免LC术中胆管损伤的关键。     

腹腔镜胆囊切除术相关医源性胆管损伤多中心临床研究

目的 对我国目前腹腔镜胆囊切除术相关医源性胆管损伤病例的诊治现状进行回顾性分析、总结。方法 依托医渡云大数据平台,回顾性分析2002年3月至2018年3月我国13个省、直辖市地区的16家三甲医院中收治因胆囊良性疾病行腹腔镜胆囊切除术造成医源性胆管损伤的105例病人临床资料进行分析。结果 105例胆管损伤病人占16家医院同期收治腹腔镜胆囊切除病人的0.104%,其中男44例,女61例,年龄50.0（25~76）岁。其中损伤与修复手术在相同医院完成者34例（32.4%）,在外院发生胆管损伤后转入者71例（67.6%）。胆管损伤后最常见的临床表现依次为腹痛、发热和黄疸。所有病人中治愈率为88.5%,其中20%须行多次手术治愈,死亡1例,病死率0.95%。损伤后早期（48 h内）手术效果优于48 h以后修复者。发生损伤后首次修复失败再转入的病人治疗效果最差,均再手术。结论 腹腔镜胆囊切除术相关胆管损伤须根据损伤原因、部位与程度等综合因素行个体化胆道修复治疗,一旦发生,及时诊断并由经验丰富的专科医师进行首次确定性修复手术是改善预后的关键。     

腹腔镜胆囊切除术中医源性胆管损伤的预防

腹腔镜胆囊切除术（LC）目前已定位为良性胆囊疾病的金标准手术。医源性胆管损伤（iatrogenic bile duct injury,IBDI）是其最严重的并发症之一。如发现不及时或处理不当都可能引起严重后果。因此,LC引发的胆管损伤应引起足够的重视。术者经验不足、局部粘连严重、出血、胆道解剖变异等是导致胆管损伤的主要原因。了解LC发生IBDI的风险因素,正确处理IBDI,对避免威胁病人生存质量的后果有非常重要的意义。     

腹腔镜胆囊切除术后胆道损伤的处理策略

目的 探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）术后胆道损伤时合理的处理策略.方法 回顾性分析11年间我院处理的17例LC手术后胆道损伤的临床资料,其中胆囊床小胆管损伤4例,采用缝扎或内镜下胆道引流;主要胆管部分损伤8例,采用单纯修补、内镜下引流、放置支架或胆管空肠Roux-en-Y吻合;胆总管或肝总管完全横断4例,予对端吻合或胆肠吻合;左右肝管横断1例,二期整形后行胆肠吻合.胆道再狭窄患者予内镜下扩张并置入支架,效果不佳者行胆肠吻合.结果 所有患者均无重大并发症发生,疗效满意.结论 LC手术胆道损伤重在预防,一旦损伤,需由有经验的胆道专科医生依据损伤情况选择干预方式,方能达到最好疗效.     

Delayed presentation of bile duct injuries after laparoscopic cholecystectomy

Bile duct injury is a serious complication of laparoscopic cholecystectomy, with 50% of bile duct injuries showing a delayed presentation. We experienced four patients (one male and three female) with bile duct injuries after laparoscopic cholecystectomy performed and referred by a local practitioner. The patients' ages ranged from 34 to 63 years. Symptoms included abdominal pain, anorexia, jaundice, ascites, ileus, fever, and tarry stool. Ductal injuries were a result of electrocautery burn in two patients and biliary strictures were due to malapplication of endoclips in the remaining two. The observed bile duct injuries, confirmed by ultrasonography, computed tomography (CT) scanning, and cholangiographic studies, were successfully treated by choledochotomy with a silastic T-tube stent. To avoid bile duct injuries, laparoscopic cholecystectomy should be performed by a well trained and experienced hepatobiliary surgeon, who should ensure accurate identification of the anatomical structures of Calot's triangle, careful dissection and management of intraoperative bleeding, and a lower threshold for conversion to open surgery.     

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目的探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中行胆囊壶腹入路预防胆道损伤的临床意义。方法 2008年7月至2011年3月北京军区总医院肝胆外科应用腹腔镜胆囊壶腹入路法行胆囊切除术537例,对其临床资料进行分析。结果以壶腹部与胆囊管移行区为解剖学标志,顺利显露胆囊壶腹部、胆囊管、胆总管及胆囊动脉,均成功进行了经腹腔镜胆囊切除手术,未发生血管及胆管损伤。结论在腹腔镜胆囊切除术中,采用壶腹入路法,胆囊壶腹部与胆囊管移行区是关键解剖学标志,该区域的完整、精准显露,是成功进行腹腔镜胆囊切除术的保证,可有效避免术中胆道损伤。     

Laparoscopic cholecystectomy injury: an unusual indication for liver transplantation

The introduction of laparoscopic cholecystectomy has been associated with a rise in the number of reported bile duct injuries (0.3 %–0.8 %). Significant vascular injuries are rare (0.16 %), but may lead to life-threatening complications. We present a case report of a patient undergoing transplantion for a laparoscopic cholecystectomy injury. Received: 28 April 1998 Received after revision: 7 July 1998 Accepted: 8 July 1998