中国继续医学教育
中國繼續醫學教育
중국계속의학교육
CHINA CONTINUING MEDICAL EDUCATION
2015年
4期
109-109
,共1页
腹腔镜%胆囊切除术%胆道损伤
腹腔鏡%膽囊切除術%膽道損傷
복강경%담낭절제술%담도손상
Laparoscopic%Cholecystectomy%Biliary injury
目的：探讨腹腔镜胆囊切除术（Laparoscopic Cholecystectomy， LC）中胆道并发症的预防及治疗。方法我院在2005年3月～2013年12月所做的3000例LC手术中，其中有6例（包括外院转入1例）胆道损伤的患者，选取这些患者作为研究对象。结果7例患者右肝管夹闭1例，二次手术，去除钛夹，痊愈出院，胆总管成角部分夹闭1例，术后延迟黄疸，二次手术探查，去除钛夹缝扎胆囊管，胆道探查，“T”管引流3个月，痊愈，胆总管横断1例，肝总管横断2例，均术中发现行胆总管原位吻合，“T”管引流6个月，痊愈，肝总管横断均行胆肠吻合术Roux-en-y吻合口放置支架引流3个月痊愈，左右肝管全部清扫断，术后胆汁性腹膜炎，二次手术行肝门部胆管空肠盆式吻合1例。结论胆道损伤分主观原因和客观原因，主观上的大意及解剖的变异是LC导致胆道损伤的常见原因，胆道损伤重在预防，及时发现，尽早处理才能获得满意的预后。
目的：探討腹腔鏡膽囊切除術（Laparoscopic Cholecystectomy， LC）中膽道併髮癥的預防及治療。方法我院在2005年3月～2013年12月所做的3000例LC手術中，其中有6例（包括外院轉入1例）膽道損傷的患者，選取這些患者作為研究對象。結果7例患者右肝管夾閉1例，二次手術，去除鈦夾，痊愈齣院，膽總管成角部分夾閉1例，術後延遲黃疸，二次手術探查，去除鈦夾縫扎膽囊管，膽道探查，“T”管引流3箇月，痊愈，膽總管橫斷1例，肝總管橫斷2例，均術中髮現行膽總管原位吻閤，“T”管引流6箇月，痊愈，肝總管橫斷均行膽腸吻閤術Roux-en-y吻閤口放置支架引流3箇月痊愈，左右肝管全部清掃斷，術後膽汁性腹膜炎，二次手術行肝門部膽管空腸盆式吻閤1例。結論膽道損傷分主觀原因和客觀原因，主觀上的大意及解剖的變異是LC導緻膽道損傷的常見原因，膽道損傷重在預防，及時髮現，儘早處理纔能穫得滿意的預後。
목적：탐토복강경담낭절제술（Laparoscopic Cholecystectomy， LC）중담도병발증적예방급치료。방법아원재2005년3월～2013년12월소주적3000례LC수술중，기중유6례（포괄외원전입1례）담도손상적환자，선취저사환자작위연구대상。결과7례환자우간관협폐1례，이차수술，거제태협，전유출원，담총관성각부분협폐1례，술후연지황달，이차수술탐사，거제태협봉찰담낭관，담도탐사，“T”관인류3개월，전유，담총관횡단1례，간총관횡단2례，균술중발현행담총관원위문합，“T”관인류6개월，전유，간총관횡단균행담장문합술Roux-en-y문합구방치지가인류3개월전유，좌우간관전부청소단，술후담즙성복막염，이차수술행간문부담관공장분식문합1례。결론담도손상분주관원인화객관원인，주관상적대의급해부적변이시LC도치담도손상적상견원인，담도손상중재예방，급시발현，진조처리재능획득만의적예후。
Objective To investigate the prevention and treatment of biliary complications duing laparoscopic cholecystectomy (LC). Methods During March 2005 to December 2013, there were 3 000 cases of LC surgery conducted in our hospital, among them, 6 cases had biliary injury and were taken as the research object. Results In 6 patients, 1 case had right hepatic tube clip and was taken secondary surgery to remove titanium clamp, recovery angles bravery clip happened in 1 case, postoperative delayed jaundice, and was taken secondary surgery to remove the titanium crack cystic duct, biliary tract probe, the"T"tube drainage for 3 months. Common bile duct transection happened in 1 case. 2 cases had hepatic duct transection, and the current common bile duct anastomosis in situ, the"T"tube drainage for six month. Hepatic duct transection were biliary intestinal anastomosis Roux en-y anastomotic stent drainage, 3 months left and right hepatic duct cleaning off entirely, postoperative bile peritonitis, secondary surgical resection of the hepatic door bile duct jejunum tub of 1 case. Conclusion There are subjective reasons and objective reasons for biliary injury, prevention measures, timely detection and early treatment can achieve a satisfactory outcome.
