腹腔镜胆囊切除术胆管损伤的诊治分析

发布时间：2018-04-25 15:17

本文选题：胆囊切除术 + 腹腔镜　；参考：《中国普通外科杂志》2017年08期

【摘要】：目的:探讨腹腔镜胆囊切除术胆管损伤的治疗及预防。方法:回顾性分析2012年1月—2016年12月15例腹腔镜胆囊切除术胆管损伤的临床资料。结果:15例中4例为院内腹腔镜胆囊切除术胆管损伤,其中3例术中发现,2例行术中胆管端端吻合T管引流术,术后3个月造影通畅拔除T管;1例行右肝管修补T管引流,术后仍有胆汁漏,6个月后拔除T管。另1例术后48 h发现,行ERCP造影ENBD引流3个月治愈。另外11例系外院转入,发现胆管损伤时间2 d至6个月不等,入院后行ERCP或MRCP检查,有胆汁漏者保持引流通畅,造影提示肝门部胆管狭窄者择期行胆管空肠吻合术,术后恢复顺利。结论:腹腔镜胆囊切除术对于粘连严重或解剖变异者需要警惕胆管损伤,损伤后早期发现治疗效果好。48 h后发现者要根据损伤的分型采取不同的治疗方法。
[Abstract]:Objective: To investigate the treatment and prevention of bile duct injury in laparoscopic cholecystectomy. Methods: retrospective analysis of the clinical data of 15 cases of bile duct injury in laparoscopic cholecystectomy from January 2012 to December 2016. Results: of the 15 cases, 4 cases were treated by intraoperative laparoscopic cholecystectomy with bile duct injury, of which 3 cases were found in the operation, and 2 cases were performed intraoperative end-to-end anastomosis of T tube. The T tube was unobstructed 3 months after operation, 1 cases with right hepatic duct repair T tube drainage, bile leakage after operation, T tube removed after 6 months. 1 cases were found after 48 h after operation, and ERCP contrast ENBD drainage was cured for 3 months. The other 11 cases were transferred from 2 to 6 months, and ERCP or MRCP examination was performed after admission. There were bile leaks. Cholangiojejunostomy for the patients with stricture of the hilar bile duct with the angiography of the hepatic hilar bile duct stricture, the postoperative recovery is smooth. Conclusion: the laparoscopic cholecystectomy should be vigilant for the bile duct injury for the patients with severe adhesion or dissection, and the early discovery of the therapeutic effect after.48 h should take different treatment methods according to the type of injury.

【作者单位】：山西省临汾市人民医院普通外科;
【分类号】：R657.4

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