【摘要】 目的总结分析腹腔镜胆囊切除术(LC)相关医源性胆管损伤(IBDI)发生的经验与教训,探讨其预防措施以降低发生率。方法回顾性分析2013年1月至2018年1月该院收治的因单纯胆囊良性疾病行LC治疗患者4 031例,筛选出LC相关IBDI患者15例,对危险因素、诊断情况、预后及随访情况进行统计分析。结果 4 031例患者中,无IBDI患者的胆囊颈部结石嵌顿、胆囊三角解剖异常及其主刀医生年资等情况与LC相关IBDI患者比较,差异均有统计学意义(P<0.05)。这3个指标是影响LC相关IBDI发生的危险因素(P<0.05)。15例LC相关IBDI患者中,术中诊断7例,术后诊断8例;4例行损伤胆管结扎术,3例行损伤胆管修补术,4例行胆总管端端吻合术+T管支撑引流术,1例行胆总管空肠Roux-en-Y吻合术,2例行保守治疗,1例未行修复手术。术后随访4～60个月,术中诊断和术后诊断IBDI患者术后平均住院时间分别为(8.86±2.41)、(18.86±6.31)d,二者比较差异有统计学意义(t=-3.917,P=0.002)。所有患者均预后良好,无严重并发症,无死亡。结论严格把握LC手术指征,加强异常解剖的应变能力,谨慎耐心的手术操作可降低LC相关IBDI的发生风险。术中即时和早期完成修补术,可缩短患者住院时间,改善患者预后。更多还原

【Abstract】 Objective To summarize and analyze the experience and lessons of iatrogenic bile duct injury(IBDI)associated with laparoscopic cholecystectomy(LC),and to explore the preventive measures to reduce the incidence.Methods A retrospective analysis was made of 4 031 patients with benign gallbladder diseases treated by LC from January 2013 to January 2018.15 patients with LC-related IBDI were selected.Risk factors,diagnosis,prognosis and follow-up were analyzed.Results There were significant differences in calculus incarceration in the neck of gallbladder,abnormal anatomy of gallbladder triangle and the seniority of the chief knife doctor between the patients without IBDI and those with LC-related IBDI(P<0.05).These three indicators were risk factors for LC-related IBDI(P<0.05).Among 15 cases of LC-related IBDI,7 cases were diagnosed intraoperatively and 8 cases were diagnosed postoperatively;4 cases underwent ligation of injured bile duct,3 cases underwent repair of injured bile duct,4 cases underwent end-to-end anastomosis of common bile duct and T-tube support drainage,1 case underwent Roux-en-Y anastomosis of common bile duct and jejunum,2 cases underwent conservative treatment,and 1 case underwent no repair operation.The average hospitalization time of IBDI patients diagnosed intraoperatively and postoperatively were(8.86±2.41),(18.86±6.31)days respectively.There was a significant difference between the two groups(t=-3.917,P=0.002).All patients had good prognosis,no serious complications and no deaths.Conclusion The risk of LC-related IBDI can be reduced by strictly grasping the indication of LC operation,strengthening the ability of abnormal anatomy and careful and patient operation.Immediate and early repair can shorten hospitalization time and improve prognosis of patients.更多还原