CAJ | 학술논문

目的总结腹腔镜胆囊切除术中防治右副肝管及右肝管损伤的经验. 方法回顾性分析21例腹腔镜胆囊切除术右副肝管或左右肝管低位汇合、胆囊管汇入右肝管病例资料.结果通过术中解剖肝门及胆道造影相结合的方法,21例病例中发现右副肝管18例(I-V型),左右肝管低位汇合、胆囊管汇入右肝管3例(Ⅵ型).其中,18例具有右副肝管病例中,术中发现11例,保留副肝管未做处理3例;夹闭7例,术后皆无胆漏;术中缝合1例,术后出现胆漏,保守治疗成功.损伤右副肝管7例,2例术中夹闭损伤肝管;2例中转开腹端端吻合损伤肝管;3例术后出现胆漏,二次腹腔镜探查证实右副肝管夹闭损伤.3例左右肝管低位汇合、胆囊管汇入右肝管病例,其中术中发现2例;损伤1例,中转开腹行右肝管端端吻合.21例随访2年,皆无腹痛、黄疸、肝功能不良.结论为防止在腹腔镜胆囊切除术中损伤右肝管及右副肝管,应熟悉胆管变异的各种类型、正确解剖胆囊三角、合理应用术中胆道造影、困难病例术后放置腹腔引流管及术后剖视胆囊等多种方法相结合.不同类型的胆道损伤处理上应分别对待.
목적 총결복강경담낭절제술중방치우부간관급우간관손상적경험. 방법회고성분석21례복강경담낭절제술우부간관혹좌우간관저위회합、담낭관회입우간관병례자료.결과 통과술중해부간문급담도조영상결합적방법,21례병례중발현우부간관18례(I-V형),좌우간관저위회합、담낭관회입우간관3례(Ⅵ형).기중,18례구유우부간관병례중,술중발현11례,보류부간관미주처리3례;협폐7례,술후개무담루;술중봉합1례,술후출현담루,보수치료성공.손상우부간관7례,2례술중협폐손상간관;2례중전개복단단문합손상간관;3례술후출현담루,이차복강경탐사증실우부간관협폐손상.3례좌우간관저위회합、담낭관회입우간관병례,기중술중발현2례;손상1례,중전개복행우간관단단문합.21례수방2년,개무복통、황달、간공능불량.결론 위방지재복강경담낭절제술중손상우간관급우부간관,응숙실담관변이적각충류형、정학해부담낭삼각、합리응용술중담도조영、곤난병례술후방치복강인류관급술후부시담낭등다충방법상결합.불동류형적담도손상처리상응분별대대.
Objective To summarize our experience in the prevention and treatment of right accessory hepatic duct and right hepatic duct injury during laparoscopic cholecystectomy. Methods The clinical data of 21 cases with right accessory hepatic duct or right hepatic duct during laparoscopic cholecystectomy were reviewed retrospectively. Result According to anatomy identified by preoperative work-up and selective cholangiography during the operation, 18 cases had the right accessory hepatic duct,eleven of them were confirmed intraoperatively. The accessory hepatic ducts were conserved in 3 cases and clipped without biliary leaks postoperativly in 7 cases; One case had biliary leaks postoperatively with the duct sutured intraoperatively, and recovered well conservative therapy. Accessory hepatic ducts were accidentally injuried in 7 cases, two patients were transferred to open surgery; three cases were confirmed to be injuried and clipped by second laparoscopic exploration because of biliary leaks postoperatively. Three cases had a low confluence of the right and left hepatic duct with the gallbladder duct joining the right bile duct, the ducts were conserved in 2 cases and injuried in one. Postoperatively all these 21 cases were followed up for 2 years, without jaundice or liver dysfunction. Conclusions To prevent injury of right accessory hepatic duct and right hepatic duct. High vigilance and familiarity with the anatomic variants of the biliary tree and intraoperative cholangiography in selective cases are fundmental.