中华消化内镜杂志
中華消化內鏡雜誌
중화소화내경잡지
CHINESE JOURNAL OF DIGESTIVE ENDOSCOPY
2010年
4期
193-195
,共3页
孙登群%龚仁华%王敬民%钟兴国%曹葆强%蔡军%范育林%杨柳生%万勇%盛明辉%梁久银%汪亚华%孟翔凌
孫登群%龔仁華%王敬民%鐘興國%曹葆彊%蔡軍%範育林%楊柳生%萬勇%盛明輝%樑久銀%汪亞華%孟翔凌
손등군%공인화%왕경민%종흥국%조보강%채군%범육림%양류생%만용%성명휘%량구은%왕아화%맹상릉
胆囊切除%腹腔镜%胆管损伤
膽囊切除%腹腔鏡%膽管損傷
담낭절제%복강경%담관손상
Cholecystectomy,laparoscopic%Bile duct injury
目的 总结单中心腹腔镜胆囊切除致胆管损伤近年的变化及特点.方法 回顾性分析总结近期组(2003年6月至2009年3月)和早期组(1992年10月至1998年6月)进行腹腔镜胆囊切除术(LC)患者的临床资料,并进行对比分析.结果近期组18 613例中发生胆管损伤11例(发生率0.06%),包括胆管横断伤2例(1例是中转开腹以后发生)、胆管分离性损伤3例、电凝伤2例(肝总管1例、副肝管1例)、胆总管部分剪切伤2例、副肝管横断伤1例、中转开腹肝总管部分缝扎伤1例;早期组11 796例中发生胆管损伤15例(发生率0.13%),包括横断伤6例、电灼胆管侧壁伤6例、分离伤3例.近期组LC致胆管损伤的发生率明显低于早期组(χ~2=3.92,P=0.04784).结论 近期组LC致胆管损伤的发生率较早期组明显降低,损伤程度也在降低,但损伤种类在不断增加,依据胆管损伤的类型进行"个体化"处理可减少胆管进一步损伤以及术后并发症的发生.
目的 總結單中心腹腔鏡膽囊切除緻膽管損傷近年的變化及特點.方法 迴顧性分析總結近期組(2003年6月至2009年3月)和早期組(1992年10月至1998年6月)進行腹腔鏡膽囊切除術(LC)患者的臨床資料,併進行對比分析.結果近期組18 613例中髮生膽管損傷11例(髮生率0.06%),包括膽管橫斷傷2例(1例是中轉開腹以後髮生)、膽管分離性損傷3例、電凝傷2例(肝總管1例、副肝管1例)、膽總管部分剪切傷2例、副肝管橫斷傷1例、中轉開腹肝總管部分縫扎傷1例;早期組11 796例中髮生膽管損傷15例(髮生率0.13%),包括橫斷傷6例、電灼膽管側壁傷6例、分離傷3例.近期組LC緻膽管損傷的髮生率明顯低于早期組(χ~2=3.92,P=0.04784).結論 近期組LC緻膽管損傷的髮生率較早期組明顯降低,損傷程度也在降低,但損傷種類在不斷增加,依據膽管損傷的類型進行"箇體化"處理可減少膽管進一步損傷以及術後併髮癥的髮生.
목적 총결단중심복강경담낭절제치담관손상근년적변화급특점.방법 회고성분석총결근기조(2003년6월지2009년3월)화조기조(1992년10월지1998년6월)진행복강경담낭절제술(LC)환자적림상자료,병진행대비분석.결과근기조18 613례중발생담관손상11례(발생솔0.06%),포괄담관횡단상2례(1례시중전개복이후발생)、담관분리성손상3례、전응상2례(간총관1례、부간관1례)、담총관부분전절상2례、부간관횡단상1례、중전개복간총관부분봉찰상1례;조기조11 796례중발생담관손상15례(발생솔0.13%),포괄횡단상6례、전작담관측벽상6례、분리상3례.근기조LC치담관손상적발생솔명현저우조기조(χ~2=3.92,P=0.04784).결론 근기조LC치담관손상적발생솔교조기조명현강저,손상정도야재강저,단손상충류재불단증가,의거담관손상적류형진행"개체화"처리가감소담관진일보손상이급술후병발증적발생.
Objective To study the characteristics and changes of bile duct injury induced by lapa-roscopic cholecystectomy (LC) in recent years. Methods The clinical data of patients who underwent LC between October 1992 and June 1998 (early group) were compared with those between June 2003 and March 2009 (recent group). Results Of 18,613 cases in recent group, the bile duct injury occurred in 11 cases (0.06%), which included 2 cases of bile duct transection (occurred during open cholecystectomy in 1 case), 3 cases of dissociation impairment, 2 cases of electric coagulation injury (1 in common hepatic duct, the other accessory hepatic duct), 2 cases of partial shearing in common bile duct, 1 case of accessory he-patic duct transection, 1 case of suture injury in common hepatic duct during open cholecystectomy. In 11, 796 cases of early group, bile duct injury occurred in 15 cases (0.13%), including 6 cases of bile duct transection, 6 cases of electric coagulation injury to lateral extrahepatic bile duct and 3 cases of dissociation impairment of bile duct. Injury-rate.of bile duct in recent group was significantly lower than that of the early group (χ~2=3.92, P=0.04784). Conclusion The incidence of bile duct injury induced by LC in recent years is significantly lower than that in years before, so is the severity of injury, while the types of bile duct injury are increasing. Individualized management can prevent further injury to the bile duct, as well as post-operative complications.
