CAJ | 학술논문

目的：探讨腹腔镜胆囊切除术中遇到胆管变异的处理方法。方法回顾性分析2000例腹腔镜胆囊切除术中7例肝外胆管变异的临床资料。小肝管开口于胆囊床2例术中发现，术中采用缝扎方法，术后无胆漏。胆囊管开口于右肝管2例，均术中发现，1例胆囊管和右肝管交界处胆汁溢出，中转开腹，可吸收线缝合右肝管破口；1例腔镜下解剖清楚完成手术。右副肝管2例，1例手术中发现，开口于胆囊管，夹闭；1例胆囊切除后发现胆漏，中转开腹，结扎，术后胆漏直至无胆汁引流液后拔除引流管。1例少见胆管变异右肝外胆管直接汇入空肠，术中误认为粘连带切断，术后胆汁性腹膜炎腹腔镜下探查缝扎胆漏，二次术后无胆漏。结果7例均随访1～3年，无黄疸及肝功能异常。结论术中仔细解剖胆囊三角，提高胆管变异的认识；术毕仔细观察有无胆漏，防止遗漏胆漏；对少见变异提高防范意识，识别不清不要断管；发现胆管变异依据术中情况区别对待。
목적：탐토복강경담낭절제술중우도담관변이적처리방법。방법회고성분석2000례복강경담낭절제술중7례간외담관변이적림상자료。소간관개구우담낭상2례술중발현，술중채용봉찰방법，술후무담루。담낭관개구우우간관2례，균술중발현，1례담낭관화우간관교계처담즙일출，중전개복，가흡수선봉합우간관파구；1례강경하해부청초완성수술。우부간관2례，1례수술중발현，개구우담낭관，협폐；1례담낭절제후발현담루，중전개복，결찰，술후담루직지무담즙인류액후발제인류관。1례소견담관변이우간외담관직접회입공장，술중오인위점련대절단，술후담즙성복막염복강경하탐사봉찰담루，이차술후무담루。결과7례균수방1～3년，무황달급간공능이상。결론술중자세해부담낭삼각，제고담관변이적인식；술필자세관찰유무담루，방지유루담루；대소견변이제고방범의식，식별불청불요단관；발현담관변이의거술중정황구별대대。
Objective To explore treatment of bile duct variation in Laparoscopic Cholecystectom.Methods The author retrospectively analyzed the clinical data of 7 cases with bile duct variation in 2 000 patients performing Laparoscopic Cholecystectomy.Among the 7 cases,2 cases had small hepatic duct openings in the gallbladder bed;2 cases had cystic duct openings in the right hepatic duct;2 cases had accessory right hepatic duct;and one case had rare variation whose right hepatic bile duct and the jejunum connect together.2 cases of the first variation had no bile leakage,adopting the suture method in LC.Among 2 cases of the second variation(all found in LC),one case had bile spillage in the junction of the cystic duct and the right hepatic duct,so the operator converses to laparotomy,cuts the gallbladder,sutures the break,and the patient had no bile leakage at last;The other one case was anatomized clearly under the cavity mirror.Among 2 cases of the third variation,one had no bile leakage,whose accessory hepatic duct was ligated in LC.The other one case had bile leakage after LC,so the operator converses to laparotomy,clips the accessory hepatic duct,and extract the drainage tube until there was no bile drainage.The last case was mistaken and cut it,the next day biliary peritonitis appeared,so the bile leakage was sewed up under the laparoscope.Results The seven cases were followed 1 ~3 years,they had no jaundice and their liver function was normal.Conclusion Careful-ly dissect Calot's triangle in LC,observe bile leakage after LC;improve the level of understanding and dealing bile duct variation in LC,don't cut the duct which is known to us.We should treat differently according to particular case.