腹腔镜胆囊切除术致胆管的热力损伤

目的探讨腹腔镜胆囊切除术致胆管热力损伤的原因、特点、处理及预防方法。方法回顾总结我院1992-2002年间收治的腹腔镜胆囊切除术致胆管热力损伤的8例临床资料。结果6例表现为穿孔性损伤：右肝管损伤1例，肝总管损伤4例，胆总管损伤1例，经过1次或1次以上手术治疗后痊愈；2例表现为延迟性胆管狭窄，均为肝总管损伤，再次手术后痊愈。随访1．5～9年，无胆管狭窄。结论与机械性胆管损伤相比，腹腔镜胆囊切除术致胆管热力损伤具有一定的特点，且其病情复杂、处理困难、处理方法灵活多样；娴熟的腹腔镜技术、正确掌握中转开腹指征以及丰富的胆道外科经验是预防和处理胆道热力损伤的关键。

Bile duct heat injury caused by laparoscopic cholecystectomy

Objective To investigate the reasons, features, management and prevention of bile duct heat injury caused by laparoscopic cholecystectomy (LC). Methods The clinical data of 8 patients with LC-caused bile duct heat injury treated in our hospital from 1992 to 2002 were retrospectively analyzed. Results Six patients with manifestation of perforation injury were cured by one or more than one operations. Two patients with the manifestation of delayed bile duct stricture were cured by one operation. No biliary stricture occurred during the follow-up period of 1-9 years. Conclusions Bile duct heat injury caused by LC is different from the mechanic bile duct injury. Its state of illness is complex and its management is difficult, multiple and flexible. Skilled laparoscopic technique, precise treatment of the conversion to open operation and rich experience are important for prevention and treatment of the injury.