CAJ | 학술논문

目的探讨腹腔镜胆囊切除术(LC)中如何避免变异右后肝管损伤及损伤后的处理.方法我院2011年1月至2013年11月共进行LC 1710例.其中5例发现右后肝管变异.本文对其进行总结分析.结果术中发现右后肝管汇入胆囊体部1例(ⅠA型),右后肝管汇入胆囊管2例(ⅢA型),胆囊管汇入右后肝管2例(ⅢB型),变异以Ⅲ型多见.全组5例患者均未造成胆管损伤,其中1例中转开腹后行胆囊切除.结论右后肝管变异是LC中胆管损伤的重要原因.充分认清右后肝管变异的类型,合理实施术前MRCP及术中胆道造影,掌握合适的手术方法及技巧,可有效预防变异右后肝管损伤.
목적 탐토복강경담낭절제술(LC)중여하피면변이우후간관손상급손상후적처리.방법 아원2011년1월지2013년11월공진행LC 1710례.기중5례발현우후간관변이.본문대기진행총결분석.결과 술중발현우후간관회입담낭체부1례(ⅠA형),우후간관회입담낭관2례(ⅢA형),담낭관회입우후간관2례(ⅢB형),변이이Ⅲ형다견.전조5례환자균미조성담관손상,기중1례중전개복후행담낭절제.결론 우후간관변이시LC중담관손상적중요원인.충분인청우후간관변이적류형,합리실시술전MRCP급술중담도조영,장악합괄적수술방법급기교,가유효예방변이우후간관손상.
Objective To investigate how to avoid and deal with injuries to the aberrant right posterior hepatic duct during laparoscopic cholecystectomy (LC).Method We studied 1 710 patients who underwent LC in our unit from January 2011 to November 2013.There were 5 patients with right posterior hepatic duct abnormally,and this paper analysed the cases.Results In the 5 patients,one patient had the right posterior hepatic duct draining into the gallbladder body (Ⅰ A type),two patients had the right posterior hepatic duct draining into the cystic duct (ⅢA type),and two patients had the cystic duct draining into the right posterior hepatic duct (ⅢB type).There was no damage to the right posterior hepatic duct during operation.One patient was converted from LC to open operation.The major aberrance was class Ⅲ.Conclusions Variant bile duct is an important cause of bile duct injuries during LC.The right posterior hepatic duct variation is the most common form.To raise our vigilance and fully understand the types of aberrant right posterior hepatic duct,reasonable use of preoperative MRCP and intraoperative cholangiography in selected patients are fundamental.Aberrant right posterior hepatic duct injuries can effectively be avoided.