中国临床医学
中國臨床醫學
중국림상의학
CLINICAL MEDICAL JOURNAL OF CHINA
2014年
3期
334-335
,共2页
龚解其%严斌%陈伟新%沈卫星
龔解其%嚴斌%陳偉新%瀋衛星
공해기%엄빈%진위신%침위성
腹腔镜%胆囊切除术%胆囊管%解剖变异%诊断%处理
腹腔鏡%膽囊切除術%膽囊管%解剖變異%診斷%處理
복강경%담낭절제술%담낭관%해부변이%진단%처리
Laparoscopy%Cholecystectomy%Cystic duct%Anatomic variation%Diagnosis%Management
目的：探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy ，LC ）中胆囊管解剖变异的诊断及处理。方法：回顾分析1999年1月-2013年12月在复旦大学附属中山医院青浦分院行LC的4652例患者的临床资料，其中胆囊管发生解剖变异者34例，包括胆囊管异常粗、短11例，高位汇入右肝管7例，低位汇入肝总管下端6例，从肝总管前方绕至左侧汇入肝总管1例，与肝总管并行一段后汇入胆总管3例，M rizzi综合征4例，内脏反位2例。结果：34例胆囊管有解剖变异的患者中，22例成功行LC ，12例中转开腹行胆囊切除术。9例出现并发症，均为胆管损伤，经处理后恢复良好，无远期并发症发生。结论：LC术前难以诊断胆囊管解剖变异，LC术中重视胆囊管解剖变异、细致地解剖胆囊三角、辨认各管道关系，是预防并减少胆管损伤的关键。
目的：探討腹腔鏡膽囊切除術（laparoscopic cholecystectomy ，LC ）中膽囊管解剖變異的診斷及處理。方法：迴顧分析1999年1月-2013年12月在複旦大學附屬中山醫院青浦分院行LC的4652例患者的臨床資料，其中膽囊管髮生解剖變異者34例，包括膽囊管異常粗、短11例，高位彙入右肝管7例，低位彙入肝總管下耑6例，從肝總管前方繞至左側彙入肝總管1例，與肝總管併行一段後彙入膽總管3例，M rizzi綜閤徵4例，內髒反位2例。結果：34例膽囊管有解剖變異的患者中，22例成功行LC ，12例中轉開腹行膽囊切除術。9例齣現併髮癥，均為膽管損傷，經處理後恢複良好，無遠期併髮癥髮生。結論：LC術前難以診斷膽囊管解剖變異，LC術中重視膽囊管解剖變異、細緻地解剖膽囊三角、辨認各管道關繫，是預防併減少膽管損傷的關鍵。
목적：탐토복강경담낭절제술（laparoscopic cholecystectomy ，LC ）중담낭관해부변이적진단급처리。방법：회고분석1999년1월-2013년12월재복단대학부속중산의원청포분원행LC적4652례환자적림상자료，기중담낭관발생해부변이자34례，포괄담낭관이상조、단11례，고위회입우간관7례，저위회입간총관하단6례，종간총관전방요지좌측회입간총관1례，여간총관병행일단후회입담총관3례，M rizzi종합정4례，내장반위2례。결과：34례담낭관유해부변이적환자중，22례성공행LC ，12례중전개복행담낭절제술。9례출현병발증，균위담관손상，경처리후회복량호，무원기병발증발생。결론：LC술전난이진단담낭관해부변이，LC술중중시담낭관해부변이、세치지해부담낭삼각、변인각관도관계，시예방병감소담관손상적관건。
Objective:To explore the diagnosis and management of anatomic variation of the cystic duct during laparoscopic cholecystectomy(LC) .Methods :From Jan 1999 to Dec 2013 ,4652 cases of LC ,which were performed in Qingpu Branch of Zhongshan Hospital ,Fudan University ,were retrospectively analyzed .A total of 34 cases of anatomic variation of the cystic duct were found .Among the 34 cases of anatomic variation of the cystic duct ,11 cases had thick and short cystic duct ,7 cases had a cystic duct converged into right hepatic duct ,6 cases had cystic duct converged into lower part of common hepatic duct ,1 case had cystic duct pronated forward and converged into common hepatic duct from left side ,3 cases had cystic duct that paral-lel itself with common hepatic duct and then converged into common bile duct ,4 cases were diagnosed with Mrizzi syndrome ,2 cases had situs viscera inversus .Results:Among the 34 cases with anatomic variations of cystic duct ,22 cases successfully un-derwent LC ,the other 12 cases were converted to open cholecystectomy .All the complications were biliary duct injury that re-covered well after treatment .Conclusions :Anatomic variation of the cystic duct is hard to diagnose preoperatively .Paying More attention to the anatomic variation during LC ,dissecting calot′s triangle carefully ,and identifying the relationship between the various pipeline is the key to prevent and reduce the biliary duct injury .
