Objective To investigate the anatomic factors on iatrogenic biliary injury for elevating surgical safety and decreasing incidence of iatrogenic biliary injury. Methods The clinical data of 39 patients with iatrogenic biliary injury and anatomic varied factors in operation records from January 2000 to August 2009 in The Second Affiliated Hospital of Kunming Medical College were analyzed retrospectively. Results Thirty-nine patients with iatrogenic biliary injury were divided into 5 types according to Bismuth typing, including type Ⅰ 6 cases, type Ⅱ 19 cases, type Ⅲ 8 cases, type Ⅳ 5 cases, and type Ⅴ 1 case. Anatomic varied factors included bile duct variation in 15 cases, cystic duct abnormal position in 10 cases, vascular variation in 13 cases, and porta hepatis rotation in 1 case. Biliary injuries were found during operation in 6 cases, 24—72 h after operation in 16 cases, and stenosis of biliary duct was found in 17 cases 3 months to 2 years after operation. Two cases were dead because of liver function failure or myocardial infarction, withdraw was 4, the other patients were cured. Conclusion Anatomic factors are important objective elements in iatrogenic biliary injury, paying attention to abnormal anatomic factors can effectively prevent iatrogenic biliary injury.
目的 探讨三管一壶腹在腹腔镜胆囊切除术中的应用价值。方法 回顾性分析2011年9月至2012年6月期间九寨沟县人民医院外一科行腹腔镜胆囊切除术（术中均遵循三管一壶腹的解剖关系）的362例患者的临床资料。结果 362例患者中，慢性结石性胆囊炎317例，胆囊息肉45例。术中有3例（0.83%）患者中转开腹，2例（0.55%）患者发现副肝管，均未发生胆管损伤，无手术死亡。术后所有患者均随访半年，随访期间均无其他并发症发生，术后恢复均良好。结论 胆囊切除术中遵循三管一壶腹的解剖关系，可有效地预防胆管损伤等并发症的发生，其安全、可靠，值得推广应用。
目的 探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy,LC）导致胆管损伤的原因及防治方法。方法 回顾性分析上海仁济医院2001～2006年期间1 253例LC中发生胆管损伤14例的临床资料。结果 右肝管损伤6例，胆总管损伤4例，肝总管损伤4例。胆管损伤发生率为1.12%。结论 解剖学变异、病变的程度、手术者的技术原因和责任心是导致胆管损伤的重要原因； 术中仔细操作和解剖、及时发现胆管损伤并中转手术，根据损伤的位置及程度选择正确的处理方式是防治胆管损伤的关键。
Objective To prevent bile duct injury, a new anatomy marker, named “common bile duct window” is created. Methods From November 2005 to March 2006, 60 patients who underwent laparoscopic cholecystectomy were researched in this hospital. All data were collected, including: age, gender, course of disease, body mass index (BMI), blood lipid level (triglyceride and cholesterol), the thickness of gallbladder wall and the degree of cholecystitis. The frequency, location and mean size of “common bile duct window” were recorded and calculated. Patients were divided into two groups according to the presence of “common bile duct window”, and the diference of data between two groups was analyzed by using χ2 test or t test. Results “Common bile duct window” was found at the end of hepatoduoduenal ligament with oval-shaped, the mean longitude of “common bile duct window” was (1.20±0.60) cm, and mean width was (0.45±0.30) cm. “Common bile duct window” were found in 81.6% (49/60) of patients. Age, gender, course of disease, BMI, triglyceride and cholesterol were proved to have no relationship with the presence of “common bile duct window” （Pgt;0.05）, but the thickness of gallbladder wall and the degree of cholecystitis affected the presence （P＜0.05）. Conclusion An oval-shaped “common bile duct window” can be found in almost all patients undergoing laparoscopic cholecystectomy. During the operation, the common bile duct can be located easily by the surgeon through “common bile duct window”, thereby to avoid common bile duct injury when the cyst duct was dissected. It is believed that during laparoscopic cholecystectomy the chances of bile duct injuries can be effectively decreased by the presence of “common bile duct window”.
目的:探讨腹腔镜胆囊切除术(LC)中胆管损伤的原因及防止。方法:回顾性分析我院531例成功487例LC患者的临床资料。结果:术中胆管损伤7例:其中胆总管横断3例,胆总管灼伤2例,右胆管损伤1例,副肝管损伤1例。结论:腹腔镜胆囊切除术(LC)术中正确判断解剖关系,正确解剖和显露Calot三角是防止损伤的技术关键,防止盲目电凝、钳夹止血,以及及时的中转开腹是预防胆管损伤的有效措施。
目的 探讨医源性胆管损伤的原因、诊治及预防。方法 回顾性分析25例医源性胆管损伤。结果 医源性胆管损伤多发生于胆囊切除术，主要原因有人为因素、胆管解剖变异、局部病理因素等。胆管一旦损伤，如果首次处理不当，则可引发一系列严重并发症。各种类型的胆管损伤应采取不同方法及早处理，对胆漏、腹腔感染较重者先行胆道及腹腔引流术，3个月后再作胆道重建或修复术，手术方法以胆管空肠RouxenY吻合术最为理想。结论 提高医生对胆管损伤的警觉性，术中细致地解剖和规范的操作，是预防医源性胆管损伤的关键。
目的 总结腹腔镜胆囊切除术（LC）胆管损伤的特点和处理经验，以提高治愈率。方法 回顾性分析81例LC术中胆管损伤的临床资料。结果 49例肝总管刺破伤，及时于腹腔镜下缝合8例，中转开腹修补33例，术后发现再开腹修补8例； 12例胆总管横断伤，术中发现10例中转开腹行胆总管端端吻合术、T管支撑引流，术后发现2例先行腹腔引流，3个月后再行胆肠吻合； 8例胆总管部分夹闭者，行剖腹取钛夹、T管支撑胆管引流半年； 10例肝总管及胆总管缺损和2例肝总管缺损伴左、右肝管部分夹闭者，均先行引流，3个月后再行肝门胆管空肠吻合术。全组病例经上述治疗后均痊愈出院。结论 不同类型的胆管损伤应采用不同的方式在不同的时间进行相应处理可获良好疗效。
目的总结胆囊切除术致医源性胆管损伤的原因、诊断、治疗及预防的经验。方法回顾性分析昆明市第一人民医院2006年5月至2011年5月期间经治的17例胆囊切除术致医源性胆管损伤患者的临床资料。结果损伤部位包括隆突2例，肝总管3例，胆囊管汇入胆总管部7例，胆总管4例，副肝管1例。1例一期术中端端吻合，2例一期吻合并留置T管支撑，1例行胆囊管结扎，2例内镜下留置鼻胆管引流，4例术后内镜下留置胆管支架，6例术后行胆肠Roux-en-Y吻合，1例行脱细胞基质材料修补。随访0.3～5年，平均2.3年，效果良好16例，1例反复发生胆管炎。结论医源性胆管损伤重在预防，精细解剖胆囊三角、严格遵循“确认-剪断-确认”三步骤是防止医源性胆管损伤的关键; 及时发现和正确的处理方法是降低其死亡率及改善预后的关键。
To analyse the causes of biliary injuries and summuarize the experience of prevention of biliary injury during laparoscopic cholecystectomy (LC). Twenty-three patients with biliary duct injury were diagnosed and treated at our center between September 1992 and August 1998. The main causes were either misidentification of the bile duct or aberrant right duct as the cystic or injudicious use of thermal energy (cautery) to dissect, control bleeding, or divide tissue. Conclusion: The causes of biliary duct injury are complex. Training and experience of sugeon, the meticulous dissection of the calot′s triangle and preoperative or operative cholangiography are three key factors in prevention of biliary duct injury during LC.
目的 探讨腹腔镜胆囊切除术（LC） 中采用提胆囊壶腹、看Rouviere沟、胆囊后三角入路法切除胆囊，对成功完成LC和预防胆管、血管损伤的临床意义。方法 2009年7月至2011年12月期间应用提胆囊壶腹、看Rouviere沟、从胆囊后三角入路法（研究组） 切除胆囊112例，同期常规方法（对照组） 行LC 55例，比较2组的临床疗效。结果 2组一般临床资料比较差异无统计学意义（P＞0.05），具有可比性。研究组112例成功完成了LC，无中转开腹及并发症发生。对照组55例LC发生并发症3例，其中2例胆管损伤及1例左肝动脉损伤。研究组的并发症发生率明显低于对照组〔0 （0/112）比5.45% （3/55），P＜0.05〕，研究组和对照组间术中出血量、手术时间、住院时间及中转开腹率差异均无统计学意义 〔术中出血量： （8.95±3.95） mL比（8.09±3.91） mL，P=0.189；手术时间：（84.72±37.15） min比（77.05±37.22） min，P=0.212；住院时间：（6.40±2.39） d比（7.02±3.41） d，P=0.178〕。结论 在LC中，采用提胆囊壶腹、看Rouviere沟、从胆囊后三角入路法，相对容易精准解剖壶腹部与胆囊管移行区，完整显露胆囊壶腹部、胆囊管、胆总管及胆囊动脉，既是成功完成LC的保证，又可有效避免术中胆管和血管的损伤。