摘要
目的探讨在腹腔镜胆囊切除术中预防胆道损伤的方法,提高手术的安全性。方法自2004年1月至2005年7月采用以Rouviere's沟或线为导向的胆囊三角区解剖方法结合术中胆道造影,对440例病人进行了腹腔镜胆囊切除术。结果所有病人无一例发生胆道损伤及手术死亡。13例中转开腹(2.9%)。4例术后胆漏(0.8%),其中2例经腹腔引流管引流9天治愈;1例在“B”超引导下经皮穿刺抽吸二次治愈;1例经十二指肠内镜鼻胆管引流8天治愈。2例术后腹腔出血再次腹腔镜探查结扎止血而愈。1例因呼吸道并发症于术后一个月死亡。4次胆漏病人术后随访3～6个月无胆道遗留症状。结论以Rouviere's沟或线为导向的胆囊三角区解剖方法结合术中胆道造影可以减少胆道损伤的几率,是值得推广应用的。
Objective Exploring the methods to prevent bile duet injury in Laparoscapic cholestectomy to enhance operative safety, Methods 440 cases of Ldaparoscopic cholecystectomies were used the methods which combined Rouviere＇s sulcus with intra-operative cholangiogram to guide the commencement of dissection in the hepatobiliary triangle from January 2004 to July 2005, Results There were no bile duct injuries and deathes attributable to technical problems with the operation, 13 cases were converted to open operation （2.9%）. 4 cases had biliary leakage, Among those, 2 cases healed ofter 9d with a strain in situ, 1 case healed percutaneous aspiration two times guided by B-ultrasound, 1 case heald after 8d with a strain of endoscopic stent, 2 cases had postoperative hemorrhage healing by relaparoscopic operation, Conclusion Disseetion in hepatobiliary triangle guided by Rouviere＇s sulcus or line combined with intra-operative cholangiogram can reduce the fate of bile duct injury, It is worthy to be applied extensively.
关键词
腹腔镜
胆囊切除术
胆道损伤
预防
Laparoscopic cholecystectomy
bile duct injury
intra-operative cholangiogram
