腹腔镜胆囊切除术（LC术）致胆管损伤的诊治体会

目的：总结腹腔镜胆囊切除术（1aparoscopiccholecystectomy，LC术）中胆管损伤的诊治体会。方法：回顾19例LC术致胆管损伤病例的临床资料，分析其发生的类型及原因，并总结其诊断和治疗要点。结果：19例患者中，1例发生在左右肝管汇合以上处损伤，2例发生胆总管缺损伤，3例发生胆总管横断伤，5例发生胆总管侧面伤，3例发生胆总管钳夹但未切断，1例发生右肝管损伤，4例发生胆囊管残端漏。治疗方法应视胆管损伤类型的不同而不同。采用断端处胆管端端吻合，同时放置T管引流、单纯胆总管T管引流、开腹去除误夹夹子、ERCP检查放置鼻胆管引流及胆肠Rouxeny吻合术。胆肠Rouxeny吻合术是临床上最常用的修补胆道损伤的手术方法。随访6个月～18年，恢复好，无1例死亡。结论：胆管损伤是LC术最常见的并发症之一，规范的操作及手术适应症的掌握能减少其发生。一旦出现胆管损伤，及时诊断及正确处理能减少其不良后果。

Experience of Diagnosis and Treatment of Bile Duct Injury in Laparoscopic Cholecystectomy

Objective： To summarize the experience of diagnosis and treatment of bile duct injury （BDI） in laparoscopic cholecystectomy（LC）. Methods： The clinical data of 19 cases of bile duct injury caused by LC were retrospectively analyzed, the types of injury and treatment methods of bile duct injury were analyzed, and the key points of diagnosis and treatment of bile duct injury in LC were summarized. Results： In 19 cases, injury above the join of the right and left hepatic duct occurred in 1 case, common bile duct lack of injury occurred in 2 cases, common bile duct transection occurred in 3 cases, common bile duct side hurt occurred in 3 cases, common bile duct clamped but not cut off occurred in 3 cases, right hepatic canal injury occurred in 1 case, cystic duct stump leakage occurred in 4 cases. Treatment should vary depending on the type of BDI. Ends at the bile duct anastomosis, while placing a T-tube drainage, simple common bile duct T-tube drainage, laparotomy place mistakenly folder clip, ERCP examination placed the ENBD and bilioenteric Rouxeny anastomosis. Biliary-enteric Rouxeny anastomosis is the most commonly surgical method of repair of bile duct injury. Followed up for 6 months -18 years to restore, no deaths. Conclusion： BDI was one of the most common complications of LC technique, normative operation and mastery of the indications for surgery could reduce its occurrence. Once BDI occurred, prompt diagnosis and effective treatment could reduce the adverse consequences of bile duct injury.