【摘要】 目的分析胆囊切除术中易发生胆管损伤的高危因素，探讨损伤的原因及预防措施。方法统计１９８５年１月至１９９８年７月行胆囊切除术时发生的１２例医源性胆管损伤情况，分析与致伤有关的解剖病理因素。结果１３年中行胆囊切除４８５４例中，易致胆管损伤的高危因素有７种共４９３例，其中高位胆囊３５例损伤１例，左右肝管低位汇合４７例损伤１例，胆囊动脉变异４７例损伤１例，萎缩性胆囊炎８７例损伤１例，胆囊颈结石嵌顿１７３例损伤４例，Ｍｉｒｉｚｚｉ综合征８９例损伤３例，伴门静脉高压症１５例损伤１例。结论在上述高危情况下，行胆囊切除术者易发生医源性胆管损伤。术者应保持警惕，仔细解剖清楚，术中造影、胆道探查以及逆行胆囊切除加胆囊颈部特殊处理等有助于减少医源性胆管损伤的发生。更多还原

【Abstract】 Objective To analyze the high risk factors for which accidental injury of bile duct was prone to occur during cholecystectomy and to investigate the causes of the injury and to find the way of prevention.Methods With which 12 patients endured iatrogenic injuries of bile duct during cholecystectomy were reviewed from Junuary 1985 to July 1998 in our hospital,the high risk factors such as special gallbladder diseases or congenital abnormality of bile duct were investigated.Results There are 493 cases in which accidental injury of the bile duct was prone to occured,in 1 of 35 cases of high positioned gallbladder,in 1 of 45 cases with low positioned confluence of the right and left hepatic ducts,in 1 of 27 cases of congenital abnomality of cystic artery,in 1 of 87 cases of atrophic cholecystitis,in 4 of 173 cases of incarcerated gallstones in neck of gallbladder,in 3 of 89 cases of Mirizzi syndrome and in 1 of 15 cases complicated with portal hypertension respectively.Conclusion In above mentioned circumstance cholecystectomy is prone to cause iatrogenic injury of the bile duct,In addition to being careful in dissection exploration of biliary tract,retrograde cholecystectomy and management of incarcerated gallstones in neck of gallbladder,we should be keep in mind with the high risk factors during cholecystectomy to reduce iatrogenic injury of the bile duct.更多还原