摘要
目的:探讨腹腔镜胆囊切除术(LC)胆道损伤的预防策略。方法:采用回顾性分析方法,从HIS系统中检索2010~2018年收治的胆道损伤患者,出院诊断中检索“胆道损伤”、“胆管损伤”、“胆漏(瘘)”,剔除各种原因行胆肠吻合术后胆漏、外伤术后胆漏、胆道损伤后施行手术再次胆道狭窄等。按最常用的胆道损伤分型(Straberg)进行分型。结果:通过以上检索策略,共检索出24例LC术后胆道并发症患者,其中由外院转入20例,本院4例。2010~2018年分别为3、2、2、3、2、3、2、2、5例。其中男6例,女18例;26~74岁。按Straberg分型,A型3例,B型0例,C型3例,D型1例,E型17例。在E型中,E1型4例,E2型4例,E3型5例,E4型3例,E5型1例,其比例分别为12.5%、0、12.5%、4.2%、16.7%、16.7%、20.8%、12.5%与4.2%。经积极处理,患者均获得良好效果出院。结论:医源性胆道损伤最常见于LC术中,预防是关键。胆道损伤后,根据损伤方式、类型选择恰当的时机与方式可获得良好效果,提高患者的生活质量。
Objective:To investigate the strategies for prevention of biliary tract injury in laparoscopic cholecystectomy.Methods:Retrospective analysis was used to retrieve patients with biliary tract injury from 2010 to 2018 from HIS system.The key words in discharged diagnosis were"biliary tract injury","biliary duct injury","biliary leakage or biliary fistula".Biliary leakage after cholangiojejunostomy,biliary leakage after trauma,secondary biliary stricture after operation because of bile duct injury were removed.According to the current international classification of biliary tract injury(Straberg),the biliary tract injury was classified.Results:Through the above search strategy,24 cases of biliary complications after laparoscopic cholecystectomy were retrieved,including 20 cases transferred from outside hospital and 4 cases from author’s hospital.From 2010 to 2018 there were 3,2,2,3,2,3,2,2,5 cases of biliary tract injury.Among them,there were 6 males and 18 females with the age of 26-74 years old.According to Straberg classification,there were 3 cases of type A,0 case of type B,3 cases of type C,1 case of type D and 17 cases of type E.Among them,there were 4 cases of type E1,4 cases of type E2,5 cases of type E3,3 cases of type E4 and 1 case of type E5.The proportion was 12.5%,0,12.5%,4.2%,16.7%,16.7%,20.8%,12.5%and 4.2%respectively.All the above patients were discharged with good results after active treatment.Conclusions:Iatrogenic biliary tract injury often happens in laparoscopic cholecystectomy,and intraoperative prevention is the key.After biliary tract injury,according to the injury way and type,choosing appropriate timing and operation method can help obtain good results and improve the life quality of patients.
作者
汪庆强
彭伟
杨敏利
陆光生
刘正才
WANG Qing-qiang;PENG Wei;YANG Min-li(Shanxi Zhenghe Hospital,Xi'an 710032,China;First Affiliated Hospital of Air Force Military Medical University)
出处
《腹腔镜外科杂志》
2019年第11期841-845,共5页
Journal of Laparoscopic Surgery
基金
国家自然科学基金资助项目(81874051)
关键词
胆囊切除术
腹腔镜
并发症
防治
Cholecystectomy
laparoscopic
Complications
Prevention and treatment
