腹腔镜胆囊切除术致胆管损伤分6

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1、腹腔镜胆囊切除术胆管损伤的现状分析吴青松1刘吉佳1谢文彪1蔡泽平21南华大学附属第二医院肿瘤外科4210012湖南省郴州铁路医院普外科423000【摘要】目的了解我国当前腹腔镜胆囊切除术胆管损伤发生率、损伤类型和防治现状。方法通过在中国期刊全文数据库检索1998年至2002年近五年全国各级期刊有关腹腔镜胆囊切除术胆管损伤的论文，统计来自118个医疗单位共487例腹腔镜胆囊切除术胆管损伤。结果收集189236例腹腔镜胆囊切除术，胆管损伤449例，LC胆管损伤发生率0-5.88%，平均发生率为0.24%，个例腹腔镜胆囊切除术胆管损伤88例。详细记录胆管损伤部位、损伤类型及治疗结果的共4

2、87例，其中胆总管损伤228例(46.8%)，胆管损伤类型中以胆管横断伤多见，占250例(51.3%)，复合型损伤142例(29.2%)。术中发现胆管损伤204例(42%)，再手术率为13.8%，再手术原因中以胆管狭窄多见占77.6%，死亡率1.85%。结论腹腔镜胆囊切除术胆管损伤及损伤后胆管狭窄仍面临着挑战，腹腔镜胆管损伤的特殊性决定其防治效果及预后，减少和防止胆管狭窄是腹腔镜胆囊切除术胆管损伤修复或重建的关键，胆管壁的连续性与完整性应作为LC胆管损伤分类的主体内容。【关键词】腹腔镜胆囊切除术胆管损伤AnalysisofPreventionandTreatmentonBileDu

3、ctInjuryofLaparoscopicCholecystectomyWuQingsong1,LiuJijia1,XieWenbiao1,CaiZeping21.Departmentofoncosurgery,theSecondAffiliatedHospitalofNanhuaUniversity,Hunan421001,China2.DepartmentofGeneralSurgery,ChenzhouRailwayHospital,Hunan42300,China【Abstract】ObjectiveToinverstigatetherate,type,preventio

4、nandtreatmentofbileductinjuries(BDI)followinglaparoscopiccholecystectomy(LC)inChina.MethodsSearchingarticalsaboutBDIfollowingLCinChinaNationalFulltextDatebasebetween1998and2002werepublishedindifferentjournalsandmagazines.Totally487casesofBDIfrom118hospitalswereanalyzed.ResultsIn189236casesofLC

5、with449casesofBDI,theBDIratewas0-5.88%andtheaverageratewas0.24%.Another88casesofBDIduringLCwerecollectedbutitsnumberofLCweren’tnoted.487casesofBDIwithdetailedinformationaboutthesite,type,andeffectofpreventionandtreatmentofBDIwerecollected.With228cases(46.8%)ofcommonbileductinjuriesand250cases(

6、51.3)ofbileducttransectionwererankedthefirstplaceinthesiteandtypeofBDIrespectively.Thecombinedinjurywas142cases(29.2%)andthenumberofintraoperativediscoverywas204cases(42%).Thereoperativeratewas13.8%andthemortalityratewas1.85%.Postoperativebiliarystrictureswasthemaincauseforreoperationandtherat

7、ewas77.6%.ConclusionBDIandpostoperativebileductstricturesofLCremainaconsiderablesurgicalchallenge.ThespecificcharacteristicsofBDIfollowingLCisdirectlyrelatetoitseffectofprognosis,preventionandtreatment.ThekeytorepairandreconstructionofB