摘要
目的探讨避免腹腔镜胆囊切除术（LC）中胆管损伤的方法。方法对2014年1月至2015年12月我院收治的676例施行LC的临床资料进行回顾性分析。手术技巧包括：前哨淋巴结定位识别胆囊动脉、Rouviere沟引导定位、Calot三角360°解剖、胆囊板分离、吸引器冲洗钝性解剖、果断中转开腹等。结果本组患者无胆管意外损伤。手术时间30~110 min,平均45 min。11例中转开腹手术,其中4例因腹腔粘连严重,2例因Mirizzi综合征,1例因胆囊结肠内瘘,4例因术中冰冻病理检查提示胆囊癌,遂中转开腹行胆囊癌根治术。术中见2例少见副肝管汇入胆囊管。术后无大出血、胆漏或再次手术等。结论合理应用手术技巧能有效避免LC术中的胆管损伤。
Objective To explore the surgical skills of avoiding bile duct injury in laparoscopic cholecystectomy（LC）. Methods The clinical data of 676 cases performed LC in our hospital from Jan. 2014 to Dec. 2015 were retrospectively analyzed. Following surgical techniques included： identifing the cystic lymph node in the Calot＇s triangle, identify Rouviere＇s sulcus before clipping, 360° Calot triangle anatomy, gallbladder plate separation, with irrigation suction and blunt dissection, decisive conversion to laparotomy, etc. Results There was no bile duct injury case found in LC. The mean operation time was 45 min（30~110 min）. 11 cases were converted to open laparotomy, because of the severe Calot＇s triangle adhesion（4 cases）, Mirizzi syndrome（2 cases）, gallbladder-colon fistula（1 case）, and gallbladder carcinoma（4 cases）. Accessory hepatic duct into cystic duct was found in 2 cases. No severe complications such as postoperative hemorrhage, bile leakage, and reoperation occurred. Conclusion Reasonable application of surgery technique can effectively avoid the bile duct injury in LC.
出处
《肝胆胰外科杂志》
CAS
2016年第3期185-187,共3页
Journal of Hepatopancreatobiliary Surgery
基金
杭州市科技发展计划项目(20150733Q16)
关键词
胆囊切除术
腹腔镜
胆管损伤
副肝管
laparoscopic cholecystectomy
bile duct injury
accessory hepatic duct
